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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 />NBSGOVE-01 <br />1 1 <br />C3 Risk &Insurance Services NBS Government Finance Group <br />32605 Temecula Parkway,Suite 316 <br />Temecula CA 92592 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />GENERAL LIABILITY: <br />Additional Insured-Special Broadening Endt:391-1006 08 16 <br />Additional Insured-Completed Operations:391-1602 08 16 <br />Primary &Non-Contributory:391-1003 08 16 <br />Waiver of Subrogation:391-1003 08 16 <br />Cancellation Provision:391-1003 08 16 <br />Umbrella Cancellation Provision:CU 02 23 09 12 <br />AUTO: <br />Additional Insured:CA20 48 02 99 <br />Primary &Non-Contributory:461-0478 12 12 <br />Waiver of Subrogation:461-0500 11 13 <br />Auto Broadening Endorsement:461-0155 (9-97) <br />Auto Cancellation Provision:IL 00 17 11 98 <br />PROFESSIONAL LIABILITY: <br />Professional Liability cancellation provision:VP00061017 <br />Waiver of Subrogation VP09630819 <br />Primary and Non-Contributory:AD66160409 <br />WORKERS'COMPENSATION: <br />Waiver of Subrogation:WC040306 (Ed 04-84) <br />Cancellation Provision California WC 040601B <br />Cancellation Provision Arizona WC 02 06 01 C <br />Deductibles: <br />General Liability-$0 <br />Umbrella:$0 <br />Professional Liability-$20,000 deductible (Per Claim). <br />Umbrella goes over General Liability,Employers Liability and Auto Liability.Underlying Schedule per form 473-1103 (11/08) <br />Docusign Envelope ID: F111E3DB-87BF-83BA-82F6-49452934899E