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DocuSign Envelope ID: FCC003D1-05FF-4218-868F-50402CE3790D <br /> AGENCY CUSTOMER ID: 412600 <br /> LOC#: <br /> ARD ADDITIONAL REMARKS SCHEDULE Page 2_of 2 <br /> AGENCY NAMED INSURED <br /> Willis North America Inc. <br /> Willis of New York, Inc. and its subsidiaries <br /> POLICY NUMBER 200 Liberty Street <br /> New York, NY 10281 <br /> See First Page <br /> CARRIER NAIC CODE <br /> See First Page EFFECTIVE DATE: See First Page <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 /> Professional Indemnity Insurance (Errors & Omission Liability) Carrier: Stone Mountain Insurance <br /> Company and various carriers <br /> ACORD 101 (2008/01) Coll:4963466 Tp1:2072494 Cert:24682255 ©2008 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />