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DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E <br /> AGENCY CUSTOMER ID: 570000032784 <br /> LOC#: <br /> ADDITIONAL REMARKS SCHEDULE Page _ of _ <br /> AGENCY NAMED INSURED <br /> Aon Risk Services Central, Inc. Res-Care, Inc. <br /> POLICY NUMBER <br /> see Certificate Number: 570088340601 <br /> CARRIER NAIC CODE <br /> See Certificate Number: 570088340601 EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br /> Additional Coverages <br /> Workers' Compensation Policies - 7/1/2021 - 7/1/2022 <br /> WLRC67822705 (All other States) - Indemnity insurance Co. of North America, NAIL #43575; <br /> WLRC67822663 (CA) - ACE American Insurance Co., NAIC #22667; <br /> SCFC67822742 (WI) - ACE Fire Underwriters Insurance Co., NAIC #20702; <br /> Cov. A - statutory <br /> COV. B - $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Agg. (Disease) <br /> Ohio/Washington Excess workers' Compensation <br /> Pol # WCUC67822626 - ACE American Insurance Co., NAIL #22667; <br /> Cov. A - Statutory <br /> Cov. B - $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Annual Aggregate <br /> Retention: $1,100,000 <br /> ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />