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CPS4073447 10/28/2024 <br /> AGENCY CUSTOMER ID: 040BQ <br /> A`"1?0 ADDITIONAL REMARKS SCHEDULE — - Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> Premier Service Insurance Agency MAJ ENGINEERING <br /> POLICY NUMBER 14608 FAWN PATH RD. <br /> CPS4073447 CHINO CA 91709 <br /> CARRIER NAIC CODE <br /> SCOTTSDALE INSURANCE COMPANY 41297 EFFECTIVE DATE:08J09J 024 <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 /> Pollution additional insured per CPS4073447 POLLUTION PRIMARY NON-CONTRIBUTORY wording per CPS4073447 Pollution waiver <br /> f subrogation applies per CPS4073447.30 Days notice of cancellation applies per CPS4073447. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of WCORD <br /> Produced using Forms Boss Web software.www.FormsBoss.com;y Impressive Publishing 800-208-1977 APPROVED <br /> By Laisa 144cra at 2:29 pm,Jan K 20251 <br />