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'lZ4, <br />et G4S SECURE SOLUTIONS (USA) A- 2011 -122-02 REVIEWED BY: 05157T'"D ICE HEREDIA (PG 2 OF 7) <br />AGENCY CUSTOMER ID: <br />LOC #: <br />A o ADDITIONAL REMARKS SCHEDULE Facie _ of <br />AGENCY <br />AOn Risk Services, Inc of Florida <br />NAMEDINSURED <br />G45 Secure Solutions (USA) InC. <br />POLICYNUMBER <br />See Certificate Number: 570059363686 <br />CARRIER <br />See Certificate Number: 570059363686 <br />NAIL CODE <br />EFFECTNE DATE: <br />AUUDIQNAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 26 FORM TITLE: Certificate of Liability Insurance <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD <br />certificate Form for policy limits. <br />INSR <br />LTR <br />TYPEOFIWSURANCE <br />ADDL <br />INSO <br />SUER <br />wVD <br />PO LILY NUMDEIt <br />POLICY <br />EFFECTIVE <br />DtTE <br />MwonM <br />POLICY <br />EXPIRATION <br />DATE <br />MMN <br />LIMITS <br />WORKERS COMPENSATION <br />C <br />N/A <br />WCO24781121 <br />FL <br />1 0 2015 <br />10 /0 2016 <br />B <br />N/A <br />wco67940050 <br />MN <br />10/01/2015 <br />10/01/2016 <br />e <br />N /A. <br />WCO24781122 <br />MA, WI - inCl. Stop Gap <br />10/01/2015 <br />10/01/2016 <br />8 <br />N/A <br />WC067940056 <br />AK,AZ,IL,KY,NC,NH,UT,VA <br />1 55 <br />10 O1 2016 <br />B <br />N/A <br />WC067940049 <br />ME <br />10/01/2015 <br />10 01/2016 <br />B <br />N/A <br />WC067940051 <br />NJ, PA <br />10/01/2015 <br />10/0112016 <br />ACORD 101 12008(01) ® 200a ACORD CORPORATION, All Nghts reserved. <br />The ACORD name and logo are registered marks of ACORD <br />