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Last modified
5/3/2021 3:00:58 PM
Creation date
5/3/2021 2:59:20 PM
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Template:
Contracts
Company Name
BURGESS MOVING & STORAGE
Contract #
N-2021-084
Agency
Community Development
Expiration Date
4/26/2022
Insurance Exp Date
7/1/2021
Destruction Year
2027
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AGENCY CUSTOMER ID: INLAMOV-02 <br />KGOAD <br />A�0 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />License # 0757776 <br />NAMED INSURED <br />HUB International Insurance Services Inc. <br />Inland Moving & Storage, Inc. <br />P.O. Box 28 <br />Riverside, CA 92502 <br />POLICY NUMBER <br />EE PAGE 1 <br />CARRIER <br />NAIC CODE <br />EE PAGE 1 <br />SEE P 1 <br />EFFECTIVE DATE: SEE PAGE 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />Description of OperationslLocationsIVehicles: <br />Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any <br />rights which may be afforded within the policies to the certificate holder named below, will provide to such certificate holder notice <br />of such cancellation within thirty (30) days of the cancellation date, except in the event the cancellation is due to non-payment of <br />premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation <br />date. <br />ACORD 101 (2008101) © 2008 ACORD COF <br />The ACORD name and logo are registered marks of ACORD <br />RlskMarugemmtDMilm <br />y < REVIt is APPROVE] BY: <br />- Risk Management Analyst <br />
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