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THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liabilitv Insurance <br />I <br />I INSURER(S) AFFORDING COVERAGE <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />ADDITIONAL POLICIES <br />If a policy below does not include limit information, refer to the corresponding policy on the ACORD <br />certificate form for policy limits. <br />POLICY <br />POLICY <br />INSR <br />'TYPE OF INSURANCE <br />ADDL <br />SURR <br />POLICY NUMBER <br />EFFECTIVE <br />EXPIRATION <br />LIMITS <br />LTR <br />INSD <br />WVD <br />DATE <br />DATE <br />IMM22iniL <br />G <br />N/A <br />WC068022269 <br />01/01/2016 <br />-iMM/DD/YYYY <br />01/01/2017 <br />MA <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />