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<br />AGENCY CUSTOMER ID. <br /> <br />LOC #. <br />ADDITIONAL REMARKS SCHEDULE <br />-----"""N 0 <br />ACCPREP Page 1 of 1 <br />AGENCY <br />Bolt Insurance Agency American Grit <br />NAMED INSURED . <br />2138 Grand Canal Blvd Apt 304 • Stockton, CA 95207 POUCY NUMBER <br />975028443 <br />CARRIER <br />United Financial Casualty Company <br />NAIC CODE <br />11770 EFFECTIVE DATE: 11/17/2023 <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 />Additional Coverages <br />Insurance coverage(s) <br /> Limits <br />Uninsured/Underinsured Motorist $300,000 Combined Single Limit <br />Description of LocationNehicles/Special Items <br />Scheduled autos only <br />2017 DODGE DURANGO 1C4RDJDG4HC726060 <br />Comprehensive $500 Ded <br />Collision $500 Ded <br />Rental Reimbursement $50 Per Day ($1,500 Max) <br />Roadside Assistance Selected w/$0 Ded <br />Medical Payments $5,000 <br />2023 WE CARE Trailer R33PD1055NA220388 <br />Stated Amount $105,000 <br />Comprehensive $500 Ded <br />Collision $500 Ded <br />Roadside Assistance Selected w/$0 Ded <br />Liability coverage may not apply to all scheduled vehicles. <br />ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD