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AGENCY CUSTOMER ID: 1005974 <br />LOC #: - <br />ADDITIONAL REMARKS SCHEDULE <br />Page of <br />AGENCY <br />SL Ins=ane Aa Snoiates Inc <br />NAMEDINAURED <br />Paaifio sox icas Inc <br />Gibe: Faoifio Datacom <br />927 Calls Negocio Ste L <br />San Clemaanter CA 92675 <br />POLICY NUMBER <br />CARRIER <br />N41000DE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORO FORM, <br />FORM NUMBER! 25 _ FORM TiTLF: Certificate of Liability Insurance <br />CERTIFICATE NUMBER: REVISION NUMBER: <br />"30 Days notice of Cancellation" *10 day notice for Non -Nay <br />The ACORD name And logo are registered marks of ACORD re-gpl"eo Oy <br />z/� <br />