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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 />Turner Asphalt GC, LLC <br />5805 Lease Lane <br />Raleigh, NC 27617 <br />basis in favor of the Additional Insureds when required by written contract. A Waiver of Subrogation is included in <br />favor of the Additional Insureds under the General Liability, Auto Liability, Workers' Compensation and Umbrella <br />policies when required by written contract and as permitted by law. <br />Workers’ Compensation applies to States of: AL, CT, DC, FL, GA, KY, IL, IN, MD, MA, MI, NJ, NH, NC, PA, SC, TN, TX, <br />VA, WV. <br />General Liability and Umbrella policies do not have a residential/habitation exclusion. <br />Umbrella is follow form of the Underlying General Liability, Auto Liability and Workers Compensation (Employers <br />Liability). <br />Employers Liability for the State of Ohio is covered under General Liability. <br />General Liability and Umbrella policies do not contain an exclusion for residential construction, including apartment <br />projects. <br />General Liability - Spray Painting Operations $250 ded. each claim; Auto & Workers’ Compensation $0.00 deductible. <br />General Liability – Electronic Data Liability Limit: $1,000,000. <br />Additional Insureds: Orange County, its officers, official agents, and employees <br />INSURER AFFORDING COVERAGE: SiriusPoint Specialty Insurance Corporation NAIC#: 16820 <br />POLICY NUMBER: CPPL-S0002754-0 EFF DATE: 03/01/2023 EXP DATE: 03/01/2024 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Per Pollution Condition or Site Limit $5,000,000 <br />Total Policy Aggregate Limit $5,000,000 <br />Retention Limit $25,000 <br />ADDITIONAL REMARKS: <br />Mold is included under Pollution <br />INSURER AFFORDING COVERAGE: Aspen American Insurance Company NAIC#: 43460 <br />POLICY NUMBER: IM00Q9923 EFF DATE: 03/01/2023 EXP DATE: 03/01/2024 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Leased/Rented Contractors Equip Limit $500,000 <br />Deductible Limit $2,500 <br />ADDITIONAL REMARKS: <br />Valuation: Legal Liability up to Replacement Cost <br />Direct Physical Loss Caused by a Covered Peril (Special Form) <br />2 2 <br />Willis Towers Watson Southeast, Inc. <br />See Page 1 <br />See Page 1 See Page 1 See Page 1 <br />25 Certificate of Liability Insurance <br />W29628161CERT:3050830BATCH:24419442SR ID: <br />DocuSign Envelope ID: 797C32F6-C1CE-44EB-BF17-813A5939396C