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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 />CLUBLLC-01 <br />1 1 <br />Arthur J.Gallagher Risk Management Services,LLC RecTrac,LLC dba Vermont Systems <br />12 Market Place <br />Essex Jct,VT 05452 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />-Additional Insured by Contract,Agreement or Permit when required in a written contract with you; <br />-Waiver of Subrogation when required in a written contract with you <br />The client does not have any owned/titled vehicles at this time. <br />BA:CNA83700XX(10/2015)Extended Coverage-BA Plus-For Hired and Non-Owned Autos which provides the following: <br />-Additional Insureds Required by Written Contracts <br />-Employee-Hired Autos <br />-Waiver of Subrogation <br />-Primary and Non-Contributory When Required By Contract <br />BA:CA0444(10/13)Business Auto-Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation).Blanket when required by contract <br />with you. <br />WC:WC000313(04/84)Blanket Waiver of Subrogation when required in a written contract with you where allowed by State law. <br />WC:WC420304B(06/14)Texas Blanket Waiver of Subrogation when required in a written contract with you. <br />WC:WC430305(07/00)Utah Blanket Waiver of Subrogation when required in a written contract with you. <br />WC:G19160B(11/97)California Blanket Waiver of Subrogation when required in a written contract with you. <br />Umbrella is follow form regarding underlying:CGL BA WC <br />Prof/Cyber Retention:$200,000;Retro Active 3/23/11 <br />Prof/Cyber:GSL2302XX(06/11)CNA EPS+Technology E&O,Cyber and Multimedia Liability Insurance Policy coverage form: <br />-pg 3 Automatic Additional Insured status when required by written contract with you; <br />Prof/Cyber:CNA71810XX(11/12)Automatic Waiver of Subrogation where required by written contract with you. <br />Third Party Crime Deductible:$5,000 <br />Orange County,its officers,agents and employees are shown as additional insureds solely with respect to General Liability policy as required by written contract. <br />Workers'compensation waiver of subrogation applies in favor of certificate holder. <br />DocuSign Envelope ID: 57A293A7-E790-41D7-BF18-E42777ABBC47