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AGENCY CUSTOMER ID: <br />LOC #: <br />,a oRo® ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />Arthur J. Gallagher Risk Management Services, Inc. <br />NAMED INSURED <br />Greyhound Lines, Inc. <br />350 N. St. Paul Street <br />Dallas, TX 75201 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />endorsement-GL#63640 Policy as evidenced herein on a primarylnon=contributory basis as required by written contract with respect to Lease Agreement for the <br />�above location mentioned. A waiver of subrogation included under the Workers' Compensation Policy(bianket end't) as required by written contract with respect <br />to Lease Agreement. <br />olice of cancellation: 30 days written notice/10 days for non -pay <br />A <br />REVIEWED BY: EUNICE HEREDIA (PGJ.QF� <br />NMaJnN out �.vvvry q V 1005 AGORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />3o13 7518 <br />