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AGENCY CUSTOMER ID: <br />LOC#: <br />ACOliO°p <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />NAMED INSURED <br />WEAVER BROS INS ASSOCS INC/PHS <br />ORGANIZATIONAL QUALITY ASSOCIATES I NC. <br />2802 MOORINGS WAY SE SOUTHPORT NC 28461 <br />POLICY NUMBER <br />SEE ACORD 25 <br />CARRIER <br />NAIC CODE <br />SEE ACORD 25 <br />EFFECTIVE DATE: SEE ACORD 25 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. Notice of <br />Cancellation will be provided in accordance with Form SS1223, attached to this policy. Coverage is primary and noncontributory <br />per the Business Liability Coverage Form SS0008, attached to this policy <br />