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FORM NUMBER: <br />EFFECTIVE DATE: <br />The ACORD name and logo are registered marks of ACORD <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE <br />FORM TITLE: <br />Page of <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />ACORD 101 (2008/01) <br />AGENCY CUSTOMER ID: <br />LOC #: <br />AGENCY NAMED INSURED <br />POLICY NUMBER <br />CARRIER NAIC CODE <br />© 2008 ACORD CORPORATION. All rights reserved. <br />Insurance Office of America <br />USMASTE-01 <br />SEE PAGE 1 <br />1 <br />SEE PAGE 1 <br />ACORD 25 Certificate of Liability Insurance <br />2 <br />SEE P 1 <br />U.S. Masters Swimming, Inc. <br />8388 South Tamiami Trail, Suite 221 <br />Sarasota, FL 34238 <br />SEE PAGE 1 <br />MONTGOMERYP <br />1 <br />Description of Operations/Locations/Vehicles: <br />US Masters Swimming, Tri Valley Masters (TVM), USMS Registered Club Workouts <br />The City of Pleasanton, its officials, officers, employees and volunteers are Additional Insured with respect to General Liability per <br />form #CG2026. <br />Docusign Envelope ID: C18680C3-D9EB-824A-8003-3927D866A6CA