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DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E <br /> AGENCY CUSTOMER ID: HAVEN-2 <br /> LOC#: <br /> ACO® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> Marsh&McLennan Agency LLC Haven House,Inc. <br /> Juli Kirby <br /> POLICY NUMBER 600 W Cabarrus Street <br /> Raleigh NC 27603 <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 /> ***SEXUAL CONDUCT&PHYSICAL ABUSE--- <br /> General Aggregate Limit$1,000,000 <br /> Each Claim Limit$1,000,000 <br /> ****EMPLOYEE BENEFITS LIABILITY--- <br /> Each Employee$1,000,000 <br /> Aggregate$3,000,000 <br /> Retroactive Date:5/15/2006 <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />