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AGENCY CUSTOMER IDI <br />LOC * <br />ADDITIONAL REMARKS SCHEDULE of <br />@ 2008 ACORD CORpORATION. All righte reserved. <br />The ACORD namE snd logo rre ragleterod m{rk* of ACORD <br />sR rD: 23228082 BATCE:27111361 eSRE: r{26d2??80 <br />Page 2z <br />t{lllis lSorerc lfatssn North.aet, fnc <br />ACENCY <br />POLIOYilUITEER <br />tee PagE I <br />md itq afflli.t€g <br />{2 LougHater Drive <br />N6twll, le. 02061 <br />NAIIED INSUREDSifoca Rlsn Syse@ Inq <br />CARRIER <br />8s Page 1 <br />NAIC CODE <br />5€6 Fag6 1 EFfECnVEOATEI Sae Faqe 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACSRD FORM. <br />FORM NUMBERI 35 FORMNTLEI Certlficcts of l,idrill.ty fn:u.nse <br />INSITRER AI.E'ORDrNG covER.C,sEr gtar! IndeEnity I l]iabiu.ty Coopany <br />POITCY NITMBDRT 1000005138 (rA. m) EFF DAtEr IL/OL|aAa" ExP DAIE; rll0rl2023 <br />lrilCll; 38318 <br />ITPE OF INST'RAI{CE: <br />tloak€ls CoDpeEaation <br />E ErFloyars LtabllJ.ey <br />Per Etatutc <br />ITIHIF DESCRIPIIoN: <br />8.I,. EtrCE ACCIDENIT <br />8.I,, DISEBSE - EA EI''F <br />a.I.. DtsgBsE-FoL r.tfr <br />I,IUff lMolJl{fr <br />$2 r 000.000 <br />92 , O00,000 <br />$2,00o,0o0 <br />INEURER AFFORDINS COVE&A6E: $larr Indsrlni.gy & I,irbill'ty Codpany <br />POtrcY NUMBER: 10006?95132?1 EFF DArE: tt/AL/2022 E:Xp DATE: 7L/Atl2A23 <br />NAIC#: 38318 <br />ICFE OF TNSUIIiNICE 1 <br />Aute Li8bili,ty (lal <br />Any Auto, omed Autoq only. <br />Eiled Autos on:.y, Non-owned Autoo only <br />ITIIIIE DESCRIBTION: <br />CSL (ga aecidenb| <br />ucs*90 <br />LIMIT .6}.'OT'NT I <br />5 , 000, 000 <br />INAURER AFFORDING COVERAEE: ACE A&6risan JnsuEanoo Conpany <br />PoIrIcy NInDER: Coo G2?d16603 008 EFF DATE: LrlA1/2022 <br />NArc*:22567 <br />ExP DAIE: 11/0112023 <br />TXPA OF INSUF,f,NCE: <br />Contraoto!tc Poll,ution l,iabi]'j"Cy <br />LIVIT DESCRIATION: <br />Esoh chin <br />AlI Clatros <br />SIR <br />I.IMI! AMOSNTI <br />$10,000 .000 <br />$10.oo0,0o0 <br />$250, 000 <br />INS('RER AfFOnDING COVtrRASE| ACE Aeoriaan Insurtnce ea8prny <br />FOLICI Nul.tsER: gOO G2?416603 008 EFr DAIEr L1/OL/2O22 <br />!{AICS: 22667 <br />E;t(P DATE: 11101/2023 <br />1T9E OF INSIJRAI'ICE: <br />Profeasianal Ei,abillry <br />LTMI|I DESCRTPIION3 <br />E.ch Ctrai! <br />f,ll clai.oe <br />srR <br />LIHII AMOTINT! <br />$10. 000, 000 <br />+10,o00,000 <br />$250, 000 <br />AcoRo 101 (2008/01,