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AGENCY CUSTOMER ID: <br /> LOC#: <br /> ACo ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br /> AGENCY NAMEDINSURED <br /> CAC Specialty, LLC Sequoia One PEO, LLC.Alt Emp:Evident ID,Inc. <br /> POLICYNUMBER 1033 W.Roosevelt Way, 3rd Floor <br /> 051132447 Tempe,AZ 85288 <br /> CARRIER NAIC CODE <br /> AIU INSURANCE COMPANY 19399 EFFECTIVEDATE:4J112026 <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 /> Policy Insurer NAIC# WC Policy Client Coverage Policy <br /> Number State Effective Effective Date Expiration <br /> 051133078 'AIU INSURANCE COMPANY 19399 CA 41112026 411/2026 41112027 <br /> 051132446 'AIU INSURANCE COMPANY 19399 FL 4/112026 4/112026 41112027 <br /> 051132447 AIU INSURANCE COMPANY 19399 GA 4/112026 41112026 41112027 <br /> 51133552 AIU INSURANCE COMPANY 19399 KS 4/1/2026 41112026 41112027 <br /> 51134698 AIU INSURANCE COMPANY 19399 NJ 4/112026 41112026 11/2027 <br /> 51136054 AIU INSURANCE COMPANY 19399 PA 4/1/2026 41112026 41112027 <br /> 051132467 IU INSURANCE COMPANY 19399 VA 41112026 4/112026 11/2027 <br /> Client Coverage Effective Date represents the date coverage began in that respective state and may differ from the Policy Fffective Date. <br /> ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />