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ACORO' <br />1111,1� <br />AGENCY CUSTOMER ID: 4LEAINC-01 <br />LOC #: 1 <br />ADDITIONAL REMARKS SCHEDULE <br />MINED1 <br />Page 1 of 1 <br />AGENCY <br />License# OC41366 <br />NAMED INSURED <br />ranite Professional Insurance Brokerage, Inc. <br />2926 F Incee Dr <br />Pleasanton, CA 94588 <br />PDucYNUMelER <br />EE PAGE 1 <br />- <br />CARRIER <br />NAIC CODE <br />SEE PAGE 1 <br />EE P 1 <br />EFFECTIVE DAM: SEE PAGE 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 26 FORM TITLE: CerUOcate of Liability Insurance <br />Description of OperationslLocationsNehicles: <br />attached endorsements CG D3 81 09 15 and CA T3 53 02 15. General Liability is Primary and Non,Contributory per Form CG D3 81 <br />09 15. Waivers of Subrogation apply to General Liability, Automobile Liability and Workers Compensation Policy per attached <br />endorsements CG D3 81 0915, CA T3 53 02 15 and WC 99 03 76. 30 Day Notice of Cancellation applies on Workers' Compensation <br />and General Liability policies. <br />ACORD 101 (2008101) © 2008 ACORD C( <br />The ACORD name and logo are registered marks of ACORD <br />.�`er Risk M1lwugmtattD[uielon <br />o. REVIEWED&APPRQV®BY: <br />AIfZ ACIV44 <br />Risk Management Specialist <br />