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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 /> MARSH RISK & INSURANCE SERVICES� <br />�� <br />�� <br />�� <br />�� <br />�� <br />CONTINUED FROM DESCRIPTION SECTION: �� <br />WRITTEN CONTRACT AND ALLOWED BY LAW. �� <br />2 <br />San Francisco <br />Certificate of Liability Insurance25 <br />�� <br /> KAISER FOUNDATION HOSPITALS� KAISER FOUNDATION HEALTH PLAN, INC.� <br /> ONE KAISER PLAZA, 25B� <br />2 <br />CN101483686 <br /> OAKLAND, CA 94612 <br />Docusign Envelope ID: 1056AD7A-5F75-8291-81D6-7251B9722F37