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AGENCY CUSTOMER ID: 00002920 <br />LOC #: <br />AC:oR" ADDITIONAL REMARKS SCHEDULE Page 2 of <br />AGENCY <br />Baker, Romero & Associates Insurance Brokers, Inc. <br />NAMED INSURED <br />Galvin Preservation Associates Inc. <br />DBA GPA Consulting <br />POLICY NUMBER <br />NIA <br />CARRIER <br />Multiple Carriers <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 />(continued from Description of Operations) <br />Workers Comp: Andrea Galvin <br />Richard Galvin <br />Additional Remarks: <br />Blanket Additional Insured CGD3810915; Coverage Xtend Endorsement CGD3790219; Aggregate Limit Per Project CGD4690219; Products/Completed Ops <br />Endt. CGD3090219; 30 Day Notice of Cancellation ILT4001209; Auto Coverage Plus Endorsement CAT4200215; Auto Blanket Additional Insured Primary and <br />Non -Contributory CAT4740216; Schedule of Underlying E000030818; Waiver of Rights UM04880708;Worker's Compensation Blanket Waiver of Subrogation <br />Travelers Form WC 990376. Coverage shall not be canceled, non -renewed or materially altered except after thirty (30) days prior written notice has been <br />given. <br />Risk MntaBonalt DbiaiaD <br />=g+"n•Nerp�.,s REVIEWmAS APPR^OVE�DBfY: <br />/ N <br />®' Risk Management Spedalirt <br />The ACORD name and logo are registered marks of ACORD <br />Printed by CRS on March 19, 2024 at 01:43PM <br />