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AGENCY CUSTOMER ID: CN1 01 640 1 93 <br /> LOC#: San Francisco <br /> AC"R o ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br /> AGENCY NAMED INSURED <br /> MARSH RISK&INSURANCE SERVICES Dell Technologies Inc. <br /> and all Subsidiaries <br /> POLICY NUMBER One Dell Way-RR1-50 <br /> Round Rock,TX 78682 <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 /> DELL INC.-WORKERS COMPENSATION/EMPLOYERS LIABILITY; EFFECTIVE 3/1/2019- EXPIRATION 3/1/2020 <br /> Insurer: New Hampshire Insurance Co. NAIC#23841 <br /> WC012717139-All Other States <br /> WC012717141-FL <br /> WC012717142-MA,WI,WY and Stop Gap EL:ND,OH,WA <br /> WC012717138-AK,AZ,IL,KY NC,NH,NJ,PA,UT,VA,VT <br /> Insurer: American Home Assurance Company NAIC#19380 <br /> WC012717140-CA <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />