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AGENCY CUSTOMER ID: POLLINC-03 <br />LOC #: 1 <br />MSHIVAKUM <br />A�O <br />ADDITIONAL REMARKS SCHEDULE <br />AGENCY License # 0757776 NAMED INSURED <br />HUB International Insurance Services Inc. Polly's Inc. Kentucky Fried Chicken Of Polly's, Inc. <br />1150 E. Orangethrope Ave., Suite 101 <br />POLICY NUMBER Placentia, CA 92870 <br />SEE PAGE 1 <br />CARRIER NAIC CODE <br />SEE PAGE 1 SEE P 1 EFFECTIVE DATE: E. PAGE 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />Description of Operations/Locations/Vehicles: <br />30 Days Notice of Cancellation with regard to General liability per endorsement to follow upon issuance by carrier. <br />ACORD 101 (2008/01) © 2008 ACORD CI <br />The ACORD name and logo are registered marks of ACORD <br />Page 1 of 1 <br />Risk Mxwgemmt DtvivioD <br />REVIEWED & APPRovED BY: <br />�, A� AcWGia <br />�--� Risk Management Spea Aht <br />