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AGENCY CUSTOMER ID: 570000048582 <br />LOC P <br />`°✓ ADDITIONAL REMARKS SCHEDULE <br />Page _ of <br />AGENCY <br />ADD Risk services Northeast, Inc. <br />NAMED INSURED <br />Bureau veritas North America, Inc. <br />POLICY NUMBER <br />see Certificate Number: 570066126752 <br />CARRIER <br />see certificate Number: 570066126752 <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 G :Hartford Insurance Co Of The southeast <br />38261 <br />INSURER H :Hartford Ins Co of the Midwest <br />37478 <br />INSURER I :Property & casualty Ins Co of Hartford <br />34690 <br />INSURER I:Hartford Accident & Indemnity Company <br />22357 <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 />INBR <br />LTR <br />TYPE OR INSURANCE <br />ADDL <br />INSD <br />BDBR <br />WVD <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />MM/DD/YYYY <br />POLICY <br />EXPIRATION <br />DATE <br />MMIDD/WYY <br />LIMITS <br />WORKERS COMPENSATION <br />A <br />N/A <br />10WNS41200 <br />HI MA <br />01/01/2017 <br />01/01/2018 <br />I <br />N/A <br />IOWNS41200 <br />A2 GA BY MI MN NE OK SC <br />01/01/2017 <br />01/01/2018 <br />F <br />N/A <br />1OWNS41200 <br />IA <br />01/01/2017 <br />01/01/2018 <br />K <br />N/A <br />IOWNS41200 <br />CA INC <br />01/01/2017 <br />01/01/2018 <br />B <br />N/A <br />IOWNS41200 <br />FL NH ND ON WA WY <br />01/01/2017 <br />01/01/2018 <br />G <br />N/A <br />1OWNS41200 <br />PA <br />01/01/2017 <br />01/01/2018 <br />I <br />N/A <br />1OWNS41200 <br />BE LA VT <br />01/01/2017 <br />01/01/2018 <br />D <br />N/A <br />IOWBRs41201 <br />WI <br />0110112017 <br />01/01/2018 <br />ADORE 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. <br />The ACORO name and logo are registered marks of ACORD <br />