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AGENCY CUSTOMER ID: <br /> _ LOC#: <br /> ACC)R"® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> Arthur J.Gallagher Risk Management Services,Inc. Window World of Tampa Bay,LLC <br /> 10741 Endeavour Way,Unit C <br /> POLICYNUMBER Pinellas Park FL 33777 <br /> CARRIER NAIC CODE <br /> EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br /> General Liability: <br /> Blkt Additional Insured if required by written contract;Blkt Waiver of Subroation,if required by written contract <br /> Business Auto: <br /> Blkt Additional Insured if required by written contractl Blkt waiver of subrogation if required by written contract <br /> Workers Compensation: <br /> Blkt Waiver of Subrogation is included on workers compensation coverage if required by written contract <br /> Joseph John Pogash license#SCC131151663 <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />