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DocuSign Envelope ID:5EDEB981-591E-4B40-919A-DCDA565AD550
<br /> AGENCY CUSTOMER ID: CN102832071
<br /> LOC#: Atlanta
<br /> AC"J?o ADDITIONAL REMARKS SCHEDULE Page 2 of 2
<br /> AGENCY NAMED INSURED
<br /> MARSH USA,INC. Canteen Vending Services
<br /> 1716 Camden Ave.
<br /> POLICY NUMBER Durham,NC 27704
<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 /> Workers Compensation Continued:
<br /> Carrier:New Hampshire Insurance Company
<br /> Policy Number:WC 045886804
<br /> Effective Date:09/30/2020
<br /> Expiration Date:09/30/2021
<br /> Policy Covers States of:MA,WI,
<br /> Stop Gap Coverage:ND,OH,WA,WY.
<br /> Limit:
<br /> E.L.Each Accident:$2,000,000
<br /> E.L.Disease-Policy:$2,000,000
<br /> E.L.Disease Each Employee:$2,000,000
<br /> Workers Compensation Continued:
<br /> Carrier:National Union Fire Ins.Co.of PA
<br /> Policy Number:XW C6559404
<br /> Effective Date:09/30/2020
<br /> Expiration Date:09/30/2021
<br /> Policy Covers States of:OH(Excess WC)
<br /> Limit:
<br /> E.L.Each Accident:$2,000,000
<br /> E.L.Disease-Policy:$2,000,000
<br /> E.L.Disease Each Employee:$2,000,000
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<br /> ADDITIONAL INFORMATION
<br /> Umbrella Liability policy provides additional limits and follows the Additional Insured and Waiver of Subrogation provision of the above captioned underlying policies as shown,if
<br /> required by written contract and permitted by law.
<br /> Workers Compensation Policy#WC045886802(AOS POLICY) Covers the States of:
<br /> AK,AL,AR,AZ,CO,CT,DC,DE,GA,HI,IA,ID,IL,IN,KS,KY,LA,MD,ME,MI,MN,MO,MS,MT,NC,NE,NH,NJ,NM,NV,OK,OR,PA,RI,SC,SD,TN,TX,UT,VA,VT,WV
<br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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