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ACORD 101 (2008/01) <br />The ACORD name and logo are registered marks of ACORD <br />© 2008 ACORD CORPORATION. All rights reserved. <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER:FORM TITLE: <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY CUSTOMER ID: <br />LOC #: <br />AGENCY <br />CARRIER NAIC CODE <br />POLICY NUMBER <br />NAMED INSURED <br />EFFECTIVE DATE: <br />CLUBLLC-01 <br />1 1 <br />Arthur J.Gallagher Risk Management Services,Inc.Clubessential Holdings,LLC <br />4600 McAuley Place Ste 350 <br />Cincinnati OH 45242-4765 <br />25 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 />DocuSign Envelope ID: E67DC299-98E1-4682-B281-3085AC9FC5B4DocuSign Envelope ID: D8616E66-A1E5-427C-BF38-08F85D32580F