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AGENCY CUSTOMER ID: <br />LOC #: <br />A ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />NAMED INSURED <br />Dealey, Renton & Associates <br />PSOMAS <br />555 South Flower Street, Suite 4300 <br />POLICY NUMBER <br />Los Angeles CA 90071 <br />CARRIER <br />NAIC CODE <br />EFFECTIVE GATE: <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 />Waiver of Subrogation or Rights applies to Workers' Compensation policy only as required by a written signed contract prior to any loss <br />occurring. <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />