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AC /20 " <br />`166� <br />AGENCY CUSTOMER ID: 25084 <br />LOC #: See ACORD 25 <br />ADDITIONAL REMARKS SCHEDULE <br />Page of <br />AGENCY <br />NAMED INSURED <br />Amity Insurance Agency, Inc. <br />POLICY NUMBER <br />See Certificate <br />See ACORD 25 <br />CARRIER <br />NAIC CODE <br />See Certificate <br />EFFECTIVE DATE: 7/31/2021 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER G: American Guarantee & Liability Insurance Company <br />26247 <br />INSURER H: Great American Assurance Company <br />26344 <br />INSURER I: The First Liberty Insurance Corp. <br />33588 <br />ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy <br />limits <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />(mm/dd/yyy) <br />POLICY <br />EXPIRATION <br />DATE <br />(mm/dd/yyy) <br />LIMITS <br />D <br />EXCESS GENERAL <br />LIABILITY <br />MKLMlEUL101630 <br />7/31/2021 <br />7/31/2022 <br />AGGREGATE <br />$4,000,000 <br />E <br />UMBRELLA LIABILITY <br />79863543 <br />7/31/2021 <br />7/31/2022 <br />AGGREGATE <br />$25,000,000 <br />F <br />EXCESS LIABILITY <br />XC5EX00784211 <br />7/31/2021 <br />7/31/2022 <br />AGGREGATE <br />$15,000,000 <br />G <br />EXCESS LIABILITY <br />AEC011173107 <br />7/31/2021 <br />7/31/2022 <br />AGGREGATE <br />$25,000,000 <br />H <br />EXCESS LIABILITY <br />EXC4033298 <br />7/31/2021 <br />7/31/2022 <br />AGGREGATE <br />$10,000,000 <br />E <br />EXCESS LIABILITY <br />78187246 <br />7/31/2021 <br />7/31/2022 <br />AGGREGATE <br />$25,000,000 <br />ACCORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />�H onaNc <br />RAMwa&med Drnalan <br />REVIEWED & APPROVED BY.- <br />z <br />cc <br />Risk Management Analyst <br />