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AGENCY CUSTOMER ID: 570000051058 <br />LOC #: <br />,acoR °® AnniTIMIA1 RFMORKS SCHEDULE Page _ of _ <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 24 FORM TITLE: Certificate of Property Insurance <br />II INSURERS) AFFORDING COVERAGE I NAIC # <br />INSURER <br />INSURER <br />INSURER <br />If a policy below does not include limit information, refer to the corresponding policy on the ACORD II <br />ADDITIONAL POLICIES certificate form for policy limits. <br />INSR <br />LTR <br />TYPEOFINSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />ATE(MM/DD% YY) <br />AGENCY <br />NANED MURED <br />LIMITS <br />Ann Risk Insurance services west, Inc. <br />Tiburon, Inc. <br />POLICY NUMBER <br />See certificate Number: 570055110797 <br />CARRIER <br />see Certificate Number: 570055110797 <br />MAC CODE <br />EFFECTIVE GATE: <br />35911023 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 24 FORM TITLE: Certificate of Property Insurance <br />II INSURERS) AFFORDING COVERAGE I NAIC # <br />INSURER <br />INSURER <br />INSURER <br />If a policy below does not include limit information, refer to the corresponding policy on the ACORD II <br />ADDITIONAL POLICIES certificate form for policy limits. <br />INSR <br />LTR <br />TYPEOFINSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />ATE(MM/DD% YY) <br />POLICY EXPIRATION <br />DATE (MMMIYD -YVV <br />COVERED PROPERTY <br />LIMITS <br />INLAND MARINE <br />A <br />Installtn Flotr <br />35911023 <br />09/01/2014 <br />09/01/2015 <br />Installation <br />$2,000,000 <br />ACORD 101 (2008/02) ® 2008 ACORD CORPORATION. All rights reserved. <br />ACORD name and logo are registered marks of ACORD <br />