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ACORO®� <br />AGENCY CUSTOMER to: 25084 <br />LOC /I: See ACORD 25 <br />ADDITIONAL REMARKS SCHEDULE <br />Page of <br />AGENCY <br />NAMED INSURED <br />Amity Insurance Agency, Inc. <br />POLICYNUMBER <br />Sec CeNficate <br />See ACORD 25 <br />CARRIER <br />NAICCODE <br />a.. cetllnctle <br />EFFECTIVE DATE: 7121112020 <br />ADDITIONAL <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 />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 />TYPE OF INSURANCE <br />AODL <br />lkso <br />SUSfl <br />wV0 <br />pCU_NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />Immil l <br />POLICY <br />EXPIRATION <br />DATE <br />kansidryyl <br />LIMITS <br />D <br />EXCESS GENERAL <br />LIABILITY <br />MKLMlEUL101301 <br />7/31/2020 <br />7/31/2021 <br />AGGREGATE <br />$4,000,000 <br />E <br />UMBRELLA LIABILITY <br />79863543 <br />7/31/2020 <br />7/31/2021 <br />AGGREGATE <br />$25,000,000 <br />F <br />EXCESS LIABILITY <br />XC5EX00784201 <br />7/31/2020 <br />7/31/2021 <br />AGGREGATE <br />$15,000,000 <br />G <br />EXCESS LIABILITY <br />AEC011173106 <br />7/31/2020 <br />7/31/2021 <br />AGGREGATE <br />$25,000,000 <br />R <br />EXCESS LIABILITY <br />EXC3275819 <br />7/31/2020 <br />7/31/2021 <br />AGGREGATE <br />$10,000,000 <br />EXCESS LIABILITY <br />78187246 <br />7/31/2020 <br />7/31/2021 <br />AGGREGATE <br />$25,000,000 <br />ACCORD 101 (20081 0200R ACORD CORPORATION. All nghls reservetl. <br />The ACORD name and logo are registered marks of ACORD <br />c. Rkk MeogenadDMdm <br />9 2 REVIEWEDdt APPRovel <br />E� <br />®, Risk Management Analyst <br />