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AGENCY CUSTOMER ID: CLINI-2 <br />LOC #: <br />A� VKL! ADDITIONAL REMARKS SCHEDULE Pagel of , <br />AGENCY NAMED INSURED <br />Wood Gutmann & Bogart Insurance Brokers Clinical Laboratory of San Bernardino, Inc. <br />Geo-Monitor, Inc. <br />POLICY NUMBER PO Box 329 <br />San Bernardino CA 92402 <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />of Subrogation applies to the Workers' Compensation and General Liability, per attached <br />A mowganou um mn <br />REVIEZED&APPRweDBr. <br />ACORD 101 (2008/01) © 2008 ACORD C g-t-u1li01FD1i F� �� <br />The ACORD name and logo are registered marks of ACORD 'm' Risk Management Analyst <br />