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BlueAlly Technology Solutions, LLC <br />00013826 <br />Ironwood, a Marsh & McLennan Agency, LLC Co <br />25 Certificate of Liability Insurance: Notes <br />Workers Compensation Carriers by State: <br />Hartford Accident and Indemnity Ins. Co. - CA, GA <br />Twin City Fire Insurance Co. - FL, MD, NE, NY, OH, TX <br />Nutmeg Insurance Co. - NC, SC <br />Sentinel Insurance Co. - IA <br />Hartford Insurance Co. of the Southeast - IL, KS <br />Hartford Casualty Insurance Co. - MO <br />Hartford Insurance Co. of Illinois - PA <br />Hartford Underwriters Insurance Co. - VA <br />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 />DocuSign Envelope ID: 924F7A48-8248-48B4-9BAF-38C1D582037B