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AGENCY CUSTOMER ID: <br /> LOC#: <br /> ARD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br /> AGENCY NAMED INSURED <br /> Willis of Minnesota, Inc. HDR Engineering, Inc. <br /> 8404 Indian Hills Drive <br /> POLICY NUMBER Omaha, NE 68114 <br /> See Page 1 <br /> CARRIER NAIC CODE <br /> See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br /> requirements for CSO's. <br /> Additional Insureds: City of Everett, it officers, employees and agents. <br /> Employers Liability for the Monopolistic States of ND, OH, WA & WY is provided in the Workers Compensation policy. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br /> SR ID: 16425745 BATCH: 779194 CERT: W6877562 <br />