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G4S SECURE SOLUTIONS (USA) A- 2011- 122 -02 REVIEWED BY: 0515FT/ti ICE HEREDIA (PG 2 OF 7) <br />AGENCY CUSTOMER ID: <br />LOC #: <br />,A 40 <br />�' ADDITIONAL REMARKS SCHEDULE Pace _ of _. <br />A05NCY <br />ACT Risk Services, Inc <br />of Florida <br />NAMED INSURED <br />G45 Secure Solutions (USA) Inc. <br />POLICY NUMBER <br />See Certificate Number: <br />570059363686 <br />CARRIER <br />See Certificate Number: <br />5700593636$6 <br />NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />ADDIT10t�AL POLCCiES If a policy below does not include limit information, refer to the corresponding policy oa tho ACORD <br />certificate form for policy limits. <br />IieSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />INVD <br />POLICYNMMER <br />POLICY <br />EFFECTIVE <br />DATE <br />MM/DDIYYYY <br />POLICY <br />EXPIRATION <br />DATE <br />(M611DDMYY <br />LIMITS <br />WORKERS COMPENSATION <br />C <br />N/A <br />wc024781121 <br />PL <br />10/01/2015 <br />10/01/2016 <br />B <br />N/A <br />wco67940050 <br />MN <br />10/01/2015 <br />10/01/2016 <br />B <br />N/A <br />WCO24781122 <br />MA, WI - inCl. Stop Gap <br />10/01/2015 <br />10/01/2016 <br />B <br />N/A <br />WC067940056 <br />AK,AZ,IL,KY,NC,N[I,UT,VA <br />770-170-15 <br />10/01/2016 <br />B <br />N/A <br />WC067940049 <br />ME <br />1010112015 <br />10/01/2016 <br />B <br />N/A <br />KQ67940051 <br />NI, PA <br />10/01/2015 <br />10/01/2016 <br />ACORD 101 (2000101) © 2008 ACORD CORPORATION. All rights resomed. <br />The ACORD name and ]ago are registered marks ofAGORO <br />