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ACORO" <br />llkl� <br />AGENCY CUSTOMER ID: OCEABLU-06 <br />LOC #: 1 <br />ADDITIONAL REMARKS SCHEDULE <br />ADAVIS2 <br />Page 1 of 1 <br />AGENCY <br />License# 0757776 <br />NAMED INSURED <br />HUB International Insurance Services Inc. <br />Ocean Blue Environmental Services, Inc. <br />925 West Esther Street <br />Long Beach, CA 90813 <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 Operations/LocationsNehicles: <br />Subrogation applies with regards to the Workers Compensation policy when required by a written contract, per the attached <br />endorsement form WC040306 04/84. Excess Liability follows form to the General Liability, Auto Liability and Employers Liability. <br />MCS-90 applies to the Auto Liability and Excess Liability per the attached forms. <br />ACORD 101 (2003101) © 2008 ACORD COF <br />The ACORD name and logo are registered marks of ACORD <br />n:y <br />.s' <br />Risk MsnsgenadDisisinn <br />REVIEWED 6 APPROVED Sr. <br />Rm— WIMOM <br />Risk Management Analyst <br />