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AGENCY CUSTOMER ID: 370044 <br /> LOC#: New York <br /> A`COREP ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br /> AGENCY NAMED INSURED <br /> Marsh USA,Inc. ACCOUNTING PRINCIPALS <br /> /PARKER&LYNCH/AJILON <br /> POLICY NUMBER 5400 Trinity Rd.,Suite 204 <br /> Raleigh,NC 27607 <br /> CARRIER NAIC CODE <br /> EFFECTIVE DATE: <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 /> WORKERS COMP CONTINUED: <br /> INSURER:INSURANCE COMPANY OF THE STATE OF PA <br /> POLICY NUMBER:WC043409004(FL) <br /> EFFECTIVE DATE:1/1/2014 <br /> EXPIRATION DATE:1/1/2015 <br /> INSURER:INSURANCE COMPANY OF THE STATE OF PA <br /> POLICY NUMBER:WC043409000(IL,KY,NC,NH,UT,VT) <br /> EFFECTIVE DATE:1/1/2014 <br /> EXPIRATION DATE:1/1/2015 <br /> INSURER:INSURANCE COMPANY OF THE STATE OF PA <br /> POLICY NUMBER:WC043409005(ME) <br /> EFFECTIVE DATE:1/1/2014 <br /> EXPIRATION DATE:1/1/2015 <br /> INSURER:INSURANCE COMPANY OF THE STATE OF PA <br /> POLICY NUMBER:WC043409001(NJ,PA) <br /> EFFECTIVE DATE:1/1/2014 <br /> EXPIRATION DATE:1/1/2015 <br /> INSURER:INSURANCE COMPANY OF THE STATE OF PA <br /> POLICY NUMBER:WC043409006(MN) <br /> EFFECTIVE DATE:1/1/2014 <br /> EXPIRATION DATE:1/1/2015 <br /> EXCESS WORKERS COMP-OHIO ONLY: <br /> INSURER:NATIONAL INSURANCE COMPANY OF THE STATE OF PA <br /> POLICY NUMBER:WC6636254 <br /> EFFECTIVE DATE:1/1/2014 <br /> EXPIRATION DATE:1/1/2015 <br /> LIMITS: <br /> SIR:$3,000,000 <br /> EL EACH ACCIDENT:$1,000,000 <br /> EL DISEASE:$1,000,000 <br /> EL DISEASE-EACH EMPLOYEE:$1,000,000 <br /> ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />