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DocuSign Envelope ID:098B7080-775F-4220-9432-FB15222455EA <br /> AGENCY CUSTOMER ID: HAZE&SA-01 KGODWIN <br /> LOC#: 0 <br /> AFRO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> Ames&Gough 498 Seventh Avenue <br /> POLICY NUMBER New York,NY 10018 <br /> EE PAGE 1 <br /> CARRIER NAIC CODE <br /> EE 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 /> Description of Operations/Locations/Vehicles: <br /> Professional Liability policies in accordance with policy terms and conditions. <br /> Pollution Liability coverage is provided and included within the Professional Liability policy noted above. It shares the limits of the <br /> Professional Liability policy. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />