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DocuSign Envelope ID:ODC20FEA-61BA-4E8D-BB15-F9F832183998 <br /> AGENCY CUSTOMER ID: 35MOSELARC <br /> _ LOC#: <br /> AC"J?"® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> McGrifff Insurance Services Moseley Architects PC <br /> 6210 Ardrey Kell Rd,Suite 425 <br /> POLICY NUMBER Charlotte, NC 28277 <br /> CARRIER TAIC 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 /> Moseley Architects of Americas LLC <br /> BeeryRio <br /> Moseley Architects <br /> Moseley Architects of South Carolina P.C. <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 />