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AGENCY <br />MARSH :13A WC <br />POLICY WASER <br />CARRER <br />AGENCY CUSTOMER la: 040356 <br />LCC 0: 4Vashingtan <br />ADDITIONAL D; <br />NAtc came <br />77(NORTH OAPITkGL ST., NE <br />WASHINGTON, CC W02 <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS M1 SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Cerlficate of Liability Insurance <br />FIDELITY BaIDICRIME. <br />CARRIER. CPat Naxlcas Insnnnce 0=;a= iP <br />POLICY NO.: FS 234 W-54 <br />EFRt* 06,3W5+14-R302015 <br />UMIT. S25,W) Mrr <br />CED.£25tl,at <br />@ 2005 ACORD CORPORATION. All rights reserved. <br />The ACORD naams and logo ag e registered marks of ACORV <br />