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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 />PIEDMHEALT7 <br />1 1 <br />Marsh McLennan Agency Piedmont Health Services Inc. <br />88 Vilcom Center Dr,Suite 110 <br />Chapel Hill NC 27514 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />Orange County,NC,as Designated Organization,is an Additional Insured as respects General &Auto Liability when required by written contract subject to the <br />terms,conditions and exclusions of the policy. <br />Docusign Envelope ID: 63CECEA1-D8BB-4086-B7BA-20666284B037