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AGENCY CUSTOMER ID: DUTHELE-01 <br /> LOC#: <br /> A`oRD® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> IOA Insurance Services Duthie Electric Service Corp dba:Duthie Power Services <br /> 2335 E.Cherry Industrial Circle <br /> POLICY NUMBER Long Beach CA 90805 <br /> CARRIER NAIC CODE <br /> EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br /> 30 Days Notice of Cancellation with 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions. <br /> o„s`Ng Risk ManagemanEDivisinn <br /> o+ �'_ REVIEWED&APPROVED BY: <br /> 'iR till . Ai.0 Ilav t. r <br /> '® Risk Management Specialist <br /> ACORD 101 (2008/01) ©2008 ACORD 1/ <br /> The ACORD name and logo are registered marks of ACORD <br />