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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 />MARSH USA, LLC. <br />�� <br />EXTENT THAT A CLAIM ARISES FROM THE NEGLIGENCE OF SIEMENS INDUSTRY, INC. OR ITS SUBCONTRACTORS WITH RESPECT TO ALL OPERATIONS OF THE <br />CONTRIBUTORY INSURANCE TO THE�� <br />ORANGE COUNTY, ITS OFFICERS, OFFICIAL AGENTS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED UNDER THE ABOVE REFERENCED GENERAL <br />�� <br />LIABILITY INSURANCE POLICIES AND THE COVERAGE AFFORDED THE ADDITIONAL INSURED UNDER THESE POLICIES SHALL BE PRIMARY AND NON- <br />LIABILITY AND AUTOMOBILE�� <br />�� <br />�� <br />�� <br />�� <br />�� <br />�� <br />�� <br /> WAIVER OF SUBROGATION IS EFFECTUAL WHERE REQUIRED BY WRITTEN CONTRACT. �� <br />�� <br />INSURED BUT ONLY WITH�� <br />�� <br />�� <br />�� <br />�� <br />�� <br />�� <br />2 <br />Morristown <br />Certificate of Liability Insurance <br />�� <br />�� <br />�� <br />�� <br /> IF THESE POLICIES ARE CANCELLED FOR ANY REASON OTHER THAN NON-PAYMENT OF PREMIUM, THE INSURER WILL DELIVER NOTICE OF CANCELLATION TO <br />�� <br />�� <br />�� <br />�� <br />�� <br />�� <br />�� <br />RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS INDUSTRY, INC. FOR CERTIFICATE HOLDER UNDER CONTRACT. �� <br />THE CERTIFICATE HOLDER UP�� <br />�� <br />�� <br />�� <br />�� <br />25 <br />�� <br />RE: JOB NO. N/A�� <br />�� <br />�� <br /> UMBRELLA IS FOLLOW FORM OF PRIMARY SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. �� <br />�� <br />1000 DEERFIELD PARKWAY��SIEMENS INDUSTRY, INC.�� <br />�� <br />BUFFALO GROVE,IL 60089-4513�� <br />�� <br />TO 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. �� <br />�� <br />2 <br />CN102147003 <br />�� <br />�� <br />�� <br />�� <br />Docusign Envelope ID: 41FDB6BA-25A5-4679-92AC-3AB198A89E13