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DocuSign Envelope ID: 109A31B0-29AD-4F2B-8257-8D55D4FF0808 <br /> AGENCY CUSTOMER ID: 35SMEINC <br /> LOC M <br /> ACaRO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> McGriff Insurance Services S&ME Inc. <br /> 3201 Spring Forest Road <br /> POLICY NUMBER Raleigh,NC 27616 <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 /> would be provided with notice of cancellation of the policy. <br /> Project:Orange Cc-Hillsborough PRLF(Project No.4305-17-061) <br /> Orange County,North Carolina is included as Additional Insured with respect to General Liability and Automobile Liability Coverage.Umbrella Liability is written <br /> on a Fallow-Farm basis over the underlying General Liability,Automobile Liability and Employers Liability policies.Professional Liability includes Contractors <br /> Pollution Legal Liability and is written an a claims-made basis.As per policy details,Certificate Holder is included as an INSURED for Contractors Pollution Legal <br /> Liability if required by written agreement,but solely to the extent that the NAMED INSURED'S liability arises out of Contracting Services rendered by or on behalf <br /> of the INSURED. <br /> ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />