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DocuSign Envelope ID: 7295DAE7 -1 D24- 460B- 843D- 4875267133AA <br />AGENCY CUSTOMER ID: NWPOOLE -01 <br />LOC <br />Ac�iR" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br />16-.� <br />AGENCY <br />Jones Insurance Agency Inc. <br />NAMED INSURED <br />Letc© nc dba N W Poole Well & Pump Co <br />P.O. Box 1958 <br />Wendell NC 277591 <br />POLICY NUMBER <br />CARRIER <br />NAIL CODE <br />EFFECTIVE DATE: <br />ALJLJI l IUNAL. <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABtLrFY INSURANCE <br />there Is a written "insured contract' between named insured and certificate holder that requires such status. <br />follow form and extends over listed liability policies. <br />ACORD 101 (2408101) U 2008 ACORD GURPURA T-KJN. All rlgnts reserves. <br />The ACORD name and logo are registered marks of ACORD <br />