Insurance ACORQ AGENCY CUSTOMER ID:
LOC#:
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY NAMED INSURED
Insurance Planning, Inc. Palmer Truck & Trailer Repair
POLICY NUMBER 2700 N. Sth •
Salina, KS 67401
CARRIER NAIL CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: ACORD Certificate of Liability Insurance
Garage Liability
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD POLICY NUMBER DATE(MMIDD/YY) DATE(MAVDD/YY) LIMITS
AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGO $
Automobile Liability
INSR ADD'L POUCY EFFECTIVE POLICY EXPIRATION
LTR INSRD POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY)
A
Excess/Umbrella Liability
INSR ADD'L POUCY EFFECTIVE POLICY EXPIRATION
LTR INSRD POUCY NUMBER DATE(MWDD/YY) DATE(MM/DD/YY) LIMITS
S
Other Liability
INSR POUCY EFFECTIVE POLICY EXPIRATION
LTR POLICY NUMBER DATE(MWDD/YY) DATE(MMIDDIYY) LIMITS
A
ACORD 101 (2008/01) ®2008 ACORD CORPORATION. All rights reserved.
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