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Additional Coverages <br />AGENCY CUSTOMER ID: <br />ADDITIONAL REMARKS SCHEDULE <br />LOC #: <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 />EFFECTIVE DATE: <br />CARRIER NAIC CODE <br />POLICY NUMBER <br />NAMED INSUREDAGENCY <br />See Certificate Number: <br />See Certificate Number: <br />Aon Risk Services Central, Inc. <br /> 570000032784 <br /> 570099458269 <br /> 570099458269 <br />Page _ of _ <br />BrightSpring Health Services <br />Workers' Compensation Policies - 7/1/2022 - 7/1/2023 <br />WLR C70303723 (All Other States) - Indemnity Insurance Co. of North America, NAIC #43575; <br />WLR C70303681 (CA, AZ) - ACE American Insurance Co., NAIC #22667; <br />SCF C70303760 (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 # WCU C70303607- ACE American Insurance Co., NAIC #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 />DocuSign Envelope ID: 05AE0BF1-7F33-40F9-942A-74F6CD86FEE3