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AGENCY CUSTOMER ID: <br />LOC # <br />CERTIFICATE: 1729889 DATE ISSUED: 1/31/14 <br />ACORQ,. ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br />AGENCY <br />K & K INSURANCE GROUP, INC. <br />POLICY NUMBER <br />GL KE00003979200 <br />CARRIER <br />SEE ACORD 25 <br />ADDITIONAL REMARKS <br />NAIC CODE <br />NAMED INSURED <br />SAND & SAGE SPORTS CAR CLUB <br />P.O. BOX 5135 <br />BENTON CITY, WA 99320 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />ADDITIONAL INSURED: PER POLICY <br />A. ANY PERSON OR ORGANIZATION ENGAGED IN OPERATING, MANAGING <br />SANCTIONING, OR SPONSORING THE "COVERED PROGRAM" OR PROVIDING THE <br />PREMISES FOR A "COVERED PROGRAM" INCLUDING OFFICIALS OF THE <br />"COVERED PROGRAM" <br />B. ANY PARTICIPANT (EXCLUDING DRIVERS) "COMPETITION VEHICLE" OWNER AND <br />"COMPETITION VEHICLE" SPONSOR AND OFFICIALS OF THE "COVERED <br />PROGRAM" <br />C. ANY "PARTICIPANT" DRIVER, BUT ONLY WITH RESPECT TO "BODILY INJURY" <br />OR "PROPERTY DAMAGE" TO PERSONS OTHER THAN ANY OTHER DRIVER. <br />D. KITTATAS COUNTY; BOWERS FIELD AIRPORT, BUT ONLY WITH RESPECTS TO <br />THE OPERATIONS OF THE NAMED INSURED. <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />