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DocuSign Envelope ID: DF078B63-CCED-42B9-8016-A67D8F6DF779 <br /> BROwBRO PAGE 2 <br /> NOTEPAD Ik <br /> �NsuRFUS NAME Brawn Brothers Plumbing and OP ID: DL Date 1 212 1/2021 <br /> The following forms apply if required by written/executed contract, before <br /> a loss: <br /> Additional Insured for General Liability Ongoing & Completed Operations <br /> and Primary & Non--contributory wording: CG7034(07/09) , CG7024(03/09) and <br /> CG2001(4/13) . <br /> Blanket Additional Insured applies to Contractors Pollution Liability for <br /> Ongoing & Completed Operations, when required by written contract. <br /> Designated Insured for Auto Liability: CA2048(02/99) . <br /> Blanket Waiver of Subrogation for General Liability: CG7051(06/15) . <br /> Blanket Waiver of Subrogation for Workers Compensation: WC 000313(04/84) . <br /> Blanket Waiver of Subrogation for Contractors Pollution Liability. <br /> Contractors Pollution Liability: Self-Insured Retention $2,500. <br /> Contractors Pollution Liability: Includes Mold Liability at $2,000,000. <br /> limit. <br /> Contractors Pollution Liability: Mold deductible $2,500. <br /> Excess liability policy over Professional/Pollution Liability Policy <br /> $1,000,000. Lloyds of London-Policy #EL00-53-0009-2021 (Effective <br /> 10/07/2021M06/03/2022.) <br /> Blanket Additional Insured on Automobile Liability, with Primary and <br /> Non-contributory wording, per attached form CA3000(07/14) . <br /> Umbrella follows form for General Liability, Automobile Liability and <br /> Workers Compensation. <br />