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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 />SIR: $500,000� <br />� <br />Carrier: ACE American Insurance Company (NAIC 22667) � <br />Expiration Date: 06/01/2024 � <br />� <br />Policy Number: WCUC70312682 (OH XS Workers' Compensation)� <br />Policy Number: WCUC70312645 (CA, FL, GA, NC, PA, VA) XS Workers' Compensation)� <br />22 <br />Policy Number: SCFC70312608 (WI)� <br />� <br />Richmond <br />Carrier: Indemnity Insurance Company of North America (NAIC 43575) � <br />Policy Number: WLRC70312761 (AOS)� <br />Expiration Date: 06/01/2024� <br />Effective Date: 06/01/2023� <br />Workers' Compensation Policies: � <br />�� <br />� <br />� <br />Certificate of Liability Insurance <br />Effective Date: 06/01/2023� <br />CN103091922 <br />Carrier: ACE Fire Underwriters Ins. Co. (NAIC 20702) � <br />Expiration Date: 06/01/2024� <br />Expiration Date: 06/01/2024� <br />� <br />Policy Number: WLRC70312724 (AZ, MA)� <br />� <br />Effective Date: 06/01/20223 � <br />Carrier: ACE American Insurance Company (NAIC 22667) � <br />� <br />Carrier: ACE American Insurance Company (NAIC 22667) � <br />Expiration Date: 06/01/2024� <br /> MARSH USA LLC.� Advance Auto Parts, Inc.� Advance Stores Company, Incorporated and� <br /> Raleigh, NC 27609 <br /> 4200 Six Forks Road� <br />� <br />SIR: $750,000� <br />Effective Date: 06/01/2023� <br />25 <br /> Effective Date: 06/01/2023� <br />DocuSign Envelope ID: 4B2967B1-C751-4175-ABF1-939E1B773F8B