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AGENCY CUSTOMER ID: CN103820276 <br />LOC #: San Antonio <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />Marsh USA, Inc.❑ <br />NAMEDINSURED <br />Dynamex Operations West, Ii <br />2051 Raymer Avenue, Unit A❑ <br />Fullerton, CA 92833 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />The above Workers Compensation policy WA2137D170841015 with Liberty Mutual Fire Insurance Company was placed by Marsh USA, Inc. Seabury & Smith, Inc. has only acted In the role of a consultant to this <br />placement, which is indicated here for your convenience. ❑ <br />The above Umbrella policy XYZ00057980336 with Allianz was placed by Marsh Canada Limited. Seabury & Smith, Inc has only acted in the role of a consultant to this placement, which is indicated here for your <br />convenience. ❑ <br />The ACORD name and logo are registered marks of ACORD <br />V�"'✓k'cvWv ID'S '11 <br />