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AGENCY CUSTOMER ID: <br /> LOC#: <br /> r� ryr• <br /> ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br /> AGENCY NAMED INSURED <br /> PLATINUM INSURANCE GROUP INC WESTERN AV INC <br /> POLICY NUMBER 1521 E ORANGETHORPE AVE STE A <br /> SEE ACORD 25 FULLERTON CA 92831-5203 <br /> CARRIER NAIC CODE <br /> SEE ACORD 25 <br /> EFFECTIVE DATE:SEE ACORD 25 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br /> FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br /> Certificate holder is an additional insured per the Business Liability Coverage Form SL3032 attached to this policy. Waiver of <br /> Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL0000, attached to this policy. <br /> Coverage is primary and noncontributory per the Business Liability Coverage Form SL0000, attached to this policy. Notice of <br /> Cancellation will be provided in accordance with Form SL9013, attached to this policy. <br /> ACORD 101 (2014/01) ©2014 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />