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AGENCY CUSTOMER ID: BRUCAND-03 <br /> _ LOG#: <br /> A� ADDITIONAL REMARKS SCHEDULE Rage 1 of 1 <br /> AGENCY NAMEDINSURED <br /> BHIS-Colossus-Alkeme Insurance Bruce Anderson Enterprises,Inc.dba Ns Construction <br /> 1662 West McFadden Ave <br /> POLICY NUMBER Santa Ana CA 92704 <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 /> Work Comp waiver of subrogation applies per attached form 10171 4-18 as respects to insureds operations. <br /> `30 days notice of cancellation except 10 days for non-payment of premium. <br /> Subject to all policy terms,conditions and exclusions. <br /> ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />