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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 />PROSH-1 <br />1 1 <br />Cobbs Allen Proshot Concrete,Inc. <br />4158 Musgrove Drive <br />Florence,AL 35630 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />-30 Day notice of cancellation per policy terms and conditions. <br />Auto Liability- <br />-Designated Insured Blanket <br />-Waiver of Subrogation Blanket <br />-Blanket Additional Insured and Loss Payee <br />-30 Day notice of Cancellation per policy terms and conditions <br />Work Comp- <br />-Blanket Waiver of Subrogation <br />-Alternate Employer Endorsement <br />-Longshore and Harbor Coverage <br />-30 Day Notice of Cancellation per policy terms and conditions <br />Umbrella - <br />-Follow form <br />Orange County,its officers,agents and employees are to be designated as additional insured. <br />DocuSign Envelope ID: 0DCAEC98-5F65-4949-A451-CA9E05298A58