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ACORD 101 (2014/01)© 2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />AGENCY CUSTOMER ID: <br />LOC# : <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />USAA INSURANCE AGENCY INC/PHS <br />NAMED INSURED <br />JENNIFER HINES DBA JENNIFER HINES DESIGN <br />13674 TORREY PINES DR <br />AUBURN CA 95602-8217 <br />POLICY NUMBER <br />SEE ACORD 25 <br />CARRIER <br />SEE ACORD 25 <br />NAIC CODE <br />EFFECTIVE DATE:SEE ACORD 25 <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 />Certificate holder is an additional insured per the ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION form <br />SL 30 42 attached to this policy. Notice of Cancellation will be provided in accordance with Form SL 90 13, attached to this <br />policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL 00 00, <br />attached to this policy. Coverage is primary and noncontributory per the Business Liability Coverage Form SL 00 00, attached <br />to this policy. <br />Docusign Envelope ID: 2BAF00DD-12F8-41A7-9919-3ED7DB75DE3B