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EFFECTIVE DATE: <br />NAMED INSURED <br />POLICY NUMBER <br />NAIC CODECARRIER <br />AGENCY <br />LOC #: <br />AGENCY CUSTOMER ID: <br />ofPageADDITIONAL REMARKS SCHEDULE <br />ADDITIONAL REMARKS <br />FORM TITLE:FORM NUMBER: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />ACORD 101 (2008/01) <br />J&A Insurance Agency Inc.Ems Technology Solutions, LLC dba Operative IQ <br />25 Certificate of Liability Insurance <br />Policy# UB7J299281 - Waiver of Subrogation applies per policy Blanket Waiver of Subrogation form..When our insured has agreed by executed written <br />contract. <br />Docusign Envelope ID: 25F298E4-C60A-4AA0-80BF-562FD181BF48