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ACORD 101 (2008/01) <br />The ACORD name and logo are registered marks of ACORD <br />© 2008 ACORD CORPORATION. All rights reserved. <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: FORM TITLE: <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY CUSTOMER ID: <br />LOC #: <br />AGENCY <br />CARRIER NAIC CODE <br />POLICY NUMBER <br />NAMED INSURED <br />EFFECTIVE DATE: <br /> <br />Florida (FL) <br />Eff: 01/01/2020 Exp: 01/01/2021 <br />AZ, IL, KY, NC, NH, NJ, PA, UT, VA <br />22 <br />Policy: WC020608677 (CA) <br /> <br />New Orleans <br />MA, WI, ND, OH, WA, WY <br />Policy: WC020608680 (MA & WI) <br />Eff: 01/01/2020 Exp: 01/01/2021 <br />New Hampshire Insurance Company <br /> <br /> <br /> <br />Workers Compensation Policies: <br />Certificate of Liability Insurance <br />Eff: 01/01/2020 Exp: 01/01/2021 <br />CN101638795 <br />California (CA) <br />Eff: 01/01/2020 Exp: 01/01/2021 <br />Policy: WC020608675 (FL) <br /> <br />Illinois National Ins. Co. <br />New Hampshire Ins. Co. <br /> Marsh USA, Inc. (504) 522-8541 <br /> & all subsidiaries <br /> Lamar Advertising Company <br /> Baton Rouge, LA 70896 <br /> PO Box 66338 <br />Policy: WC020608679 (Other) <br />25 <br />American Home Assurance <br />Powered by TCPDF (www.tcpdf.org) <br />DocuSign Envelope ID: 1E3EB904-9D2D-4E5A-A93F-7D930753B36B