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DocuSign Envelope ID: D5D06FFD-4F06-41F3-995C-9CC783787299 <br /> NAUTILUS INSURANCE COMPANY <br /> POLICY NUMBER: BN961618 ENDORSEMENT#-L— <br /> Named Insured: TAC WELDING LLC Agency# 3200 <br /> Endorsement Effective Date: 01/14/16 <br /> GENERAL CHANGE ENDORSEMENT <br /> IN CONSIDERATION OF A FULLY EARNED ADDITIONAL PRBHIUH OF 0100 IT IS SZR8BY UNDERSTOOD AND <br /> AGREED THAT PER PORN CO2010 (7/04) THE FOLLOWING IS ADDED AS ADDITIONAL INSURED: ORANGE <br /> COUNTY, <br /> THE INSURANCE COMPANY WITH WHICH THIS <br /> COVERAGE HAS BEEN PLACED IS NOT LICENSED <br /> BY THE STATE OF NORTH CAROLINA AND IS NOT <br /> SUBJECT TO ITS SUPERVISION. IN THE EVENT OF <br /> THE INSOLVENCY OF THE INSURANCE COMPANY, <br /> LOSSES UNDER THIS POLICY WILL NOT BE PAID <br /> BY ANY STATE INSURANCE GUARANTY OR <br /> Tax&Fee ScSQLVENCY FUND <br /> tt $ PREMIUM:E1 None 0 AP 0 RP $ 100. 00 <br /> Total Taxes&Fees$ 5 . 00 <br /> TOTAL_PREMIUM DUE$ 10 5. 0 0 <br /> All other terms and conditions remain unchanged. <br /> Date Issued: 01/14/16 Authorized Representative <br /> 690.. (p7/18) Includes copyrighted material of Insurance Services Office;Inc.,with its permission. <br /> INSURED <br />