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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 />Lamar Advertising Company <br />5321 Corporate Blvd <br />Baton Rouge, LA 70808 <br />Company Name: Orange County Government Attn: Melissa Tegeder, Risk Management Director Address: P.O. Box 8181 <br />Hillsborough, NC 27278. <br />Orange County, its officers, agents and employees are included as Additional Insureds as respects to General Liability <br />and Auto Liability. <br />Waiver of Subrogation applies in favor of Additional Insureds with respects to Workers Compensation as permitted by <br />law. <br />INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399 <br />POLICY NUMBER: WC080772145 EFF DATE: 01/01/2024 EXP DATE: 01/01/2025 <br />SUBROGATION WAIVED: Y <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Workers Compensation/ E.L. Each Accident $1,000,000 <br />Employers Liability - (CA) E.L. Disease-Ea Empl $1,000,000 <br />Per Statute E.L. Disease-Pol Lmt $1,000,000 <br />INSURER AFFORDING COVERAGE: American Home Assurance Company NAIC#: 19380 <br />POLICY NUMBER: WC080772146 EFF DATE: 01/01/2024 EXP DATE: 01/01/2025 <br />SUBROGATION WAIVED: Y <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Workers Compensation/ E.L. Each Accident $1,000,000 <br />Employers Liab-(OR) E.L. Disease-Ea Empl $1,000,000 <br />Per Statute E.L. Disease-Pol Lmt $1,000,000 <br />INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399 <br />POLICY NUMBER: WC080772147 EFF DATE: 01/01/2024 EXP DATE: 01/01/2025 <br />SUBROGATION WAIVED: Y <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Workers Compensation/ E.L. Each Accident $1,000,000 <br />Employers Liab-(WI) E.L. Disease-Ea Empl $1,000,000 <br />Per Statute E.L. Disease-Pol Lmt $1,000,000 <br />2 3 <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 />W32790476CERT:3353723BATCH:25490654SR ID: <br />DocuSign Envelope ID: EB89EFFA-000C-499D-9834-7FD40A2C16FB