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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 />CATALIS-01 <br />1 1 <br />Arthur J.Gallagher Risk Management Services,LLC Catalis Tax &CAMA,Inc. <br />3025 Windward Plaza Ste 200 <br />Alpharetta GA 30005 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />CA T4 74 edition (02-16)and CY330018 0522. <br />The Workers’Compensation,General Liability and Business Automobile policies include an endorsement providing that 30 days notice of cancellation or <br />coverage change will be furnished to the certificate holder. <br />Docusign Envelope ID: A2455941-95F3-4293-9296-9771EB64C354