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AGENCY CUSTOMER ID: 570000082030 <br />q� � LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page _ of <br />AGENCY <br />Ann Risk services central, Inc. <br />NAMED INSURED <br />Burke, Williams & Sorensen, LLP <br />POLICY NUMBER <br />see certificate Number: 570091397668 <br />CARRIER <br />See certificate Number: 570091397668 <br />NAIC 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 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />DRSD <br />SUBR <br />W VD <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />(MM IVYYYY) <br />POLICY <br />EXPIRATION <br />DATE <br />(MMMIVYYYY) <br />EMITS <br />OTHER <br />E <br />LPL7cABw3D1003 <br />01/15/2022 <br />01/15/2023 <br />B <br />LPL00003YZ <br />01/15/2022 <br />01/15/2023 <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />©2008 ACORD Riale Matagmtord Dhisien <br />REv EwED & APPROVED BY: <br />Risk Management Analyst <br />