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SGONZALEZ <br />___00044 <br />ACORO' <br />6*.� <br />AGENCY CUSTOMER ID: JAMIENG-01 <br />LOC #: 1 <br />ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />License # 0757776 <br />NAMED INSURED <br />HUB International Insurance Services Inc. <br />Jamison Engineering Contractors Inc. <br />2525 S. Yale St. <br />Santa Ana, CA 92704 <br />POLICYNUMBER <br />EE PAGE 1 <br />CARRIER <br />NAIC CODE <br />EE PAGE 1 <br />SEE P 1 <br />EFFECTIVE DATE: SEE PAGE 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORMNUMBER:.ACORD25 FORMTITLE: <br />Description of Operations/Locations/Vehicles: <br />contract per the attached endorsement form CAT499 02116. Waiver of Subrogation with regard to Workers Compensation applies <br />when required by written contract per the attached endorsement form 2572. <br />Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any <br />rights which may be afforded within the policies to the certificate holder named below, will provide to such certificate holder notice <br />of such cancellation within thirty (30) days of the cancellation date, except in the event the cancellation is due to non-payment of <br />premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation <br />date. <br />101 (2008/01) © 2008 ACORD CC <br />The ACORD name and logo are registered marks of ACORD <br />Risk MsnsgmlmtDMsIon <br />_ REVIEWED&APPROV 13&r <br />�i�ltil A+�r Acw4(o <br />® Risk Management Specialist <br />