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AGENCY CUSTOMER ID: 570000075610 <br />as LOC #: <br />"1%- O ADDITIONAL REMARKS SCHEDULE <br />Page _ of <br />AGENCY <br />Ann Risk Services South, <br />Inc. <br />NAMED INSURED <br />TSYS Merchant Solution <br />POLICYNUMBER <br />See Certificate Number: <br />570089995933 <br />CARRIER <br />See Certificate Number: <br />570089895933 <br />I NAIL CODE <br />EFFECTIVE DATE: <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 <br />INSURER <br />INSURER <br />INSURER <br />ADDITIONAL. POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD <br />certificate form for policy limits. <br />LYSR <br />LIPS <br />TYPE OF NSUIUNCE <br />ADBL <br />INSD <br />SUBR <br />WVO <br />POLICYNUMBER <br />POLICY <br />EFFECTIVE <br />OATE <br />(hIMIDDIYYYY) <br />POLICY <br />EXPOUTION <br />DATE <br />INI&vmv YY o <br />LNOTS <br />OTHER <br />A <br />E&O—MPL—XS <br />FSCE02002312 <br />12/01/2020 <br />12/01/2021 <br />Limit <br />$10,000,000 <br />ACORD 101 (2008I01) <br />The ACORD name and loan are registered marks of ACORD <br />m 2003A Risk Musigarent Divfsimt <br />y�I�,..I�,�S� [REVIEWED & APPROVED BY: <br />B,aaa+u+u/ rAkA'PYMY �. V:,ccNtJli <br />Risk Management Analyst <br />