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DocuSign Envelope ID: E67DC299-98E1-4682-B281-3085AC9FC5B4 <br /> AGENCY CUSTOMER ID: CLUBLLC-01 <br /> LOC#: <br /> AC"J?o ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> Arthur J.Gallagher Risk Management Services, Inc. Clubessential Holdings, LLC <br /> 4600 McAuley Place Ste 350 <br /> POLICY NUMBER Cincinnati OH 45242-4765 <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 /> -Additional Insured by Contract,Agreement or Permit when required in a written contract with you; <br /> -Waiver of Subrogation when required in a written contract with you <br /> PKG:CNA62665XX(10/15)CNA Paramount Technology Broadening Endorsement provides: <br /> -Employee Dishonesty including ERISA$50,000 Ea Occ Limit/$2,500 Deductible <br /> BA:CA2048(10/13)Blanket Additional Insured when required in a written contract with you <br /> BA:CA0444(10/13)Blanket Waiver of Subrogation when required in a written contract with you <br /> WC:WC000313(04/84)Blanket Waiver of Subrogation when required in a written contract with you where allowed by State law. <br /> WC:WC420304B(06/14)Texas Blanket Waiver of Subrogation when required in a written contract with you. <br /> Umbrella is follow form regarding underlying: CGL BA WC <br /> Prof/Cyber Retention: $50,000;Retro Active 3/23/11 <br /> Prof/Cyber:TCM-POL-001 (01/19)C&F TCM Technology E&O,Cyber and Multimedia Liability Insurance Policy coverage form: <br /> -pg 6 Automatic Additional Insured status when required by written contract with you; <br /> -pg 15 Automatic Waiver of Subrogation where required by written contract with you. <br /> Third Party Crime Deductible: $5,000 <br /> Excess Prof/Cyber: Underlying Limit$5,000,000;Underlying Retention$50,000; Retro Active 3/23/2020 <br /> Workers'compensation waiver of subrogation applies in favor of certificate holder. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />