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AGENCY CUSTOMER ID: <br />LOC #: <br />ACOR ADDITIONAL REMARKS SCHEDULE Page 2 of 3 <br />AGENCY <br />NAMED INSURED: SPECIAL LIABILITY INSURANCE PROURAM (SLIP) MEMBER'. <br />ALLIANT INSURANCE SERVICES, INC. <br />PAINT YOUR HEART OUT, INC. <br />1260 N. HANCOCK, SUITE 103 <br />POLICY NUMBER <br />PAC 100008202 <br />ANAHEIM, CA 02807 <br />CARRIER <br />NAIC CODE <br />ASSOCIATED INDUSTRIES INSURANCE CO. <br />23140 <br />EFFECTIVE DATE: 09 /29/13 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 (2009109) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the <br />Participation Endorsement. <br />The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation <br />endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the <br />Participating Named Insured fails to discharge, when due, any of Its obligations In connection with the payment of premium for the policy or <br />any installment thereof, the coverage may be canbeled by the Company by mailing to the Participating Named Insured at the address <br />shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be <br />effective. <br />5 1.: F" - %'o <br />„s,glnt City Atto�/ °� <br />