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DocuSign Envelope ID: 48ED1D41- DA40- 49D1- A586- 23C127C5B7EF <br />R � <br />AGENCY <br />McGrifff Insurance Services <br />POLICY NUMBER <br />CARRIER <br />4DDITIONAL REMARKS <br />AGENCY CUSTOMER ID: 35MOSELARC <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br />NAMED INSURED <br />Moseley Architects PC <br />11430 North Community House Road, Suite 225 <br />Charlotte, NC 28277 -1502 <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />Moseley Architects of Americas LLC <br />BeeryRio <br />Moseley Architects <br />Moseley Architects of South Carolina P.0 <br />RE: Contract No. 550352, Orange County New Detention Center Orange County, its officers, official agents and employees are included as Additional Insured <br />with respect to General Liability Coverage per Endorsement CGD381 09/07. 30 days' Notice of Cancellation other than nonpayment of premium will be sent to <br />Orange County. Waiver of Subrogation is included with respect to Worker's Compensation Coverage. <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />