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DocuSign Envelope ID:67496B91-FCOD-4188-A6C5-F7496722386E <br /> AGENCY CUSTOMER ID: FEDEENG-01 MSANDY <br /> LOC#: <br /> ' �%. ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> Preferred Insurance Services, Inc Federal Engineering, Inc. <br /> 10600 Arrowhead Drive#160 <br /> POLICY NUMBER Fairfax,VA 22030 <br /> Fairfax <br /> EE PAGE 1 <br /> CARRIER NAIC CODE <br /> ,SEE PAGE 1 ISEE P 1 EFFECTIVE DATE:SEE PAGE 1 <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 /> California Workers Compensation <br /> Workers Compensation policy 6012243496 effective 7/1/16-7/1/17 for the State of CA with limits of$1,000,000/$1,000,000/$1,000,000. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />