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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 />PRECIWALL <br />1 1 <br />Marsh McLennan Agency Precision Walls,Inc. <br />1230 NE Maynard Rd., <br />Cary,NC 27513 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />-Additional Insured on a Primary and Non-Contributory basis. <br />-Waiver of Subrogation <br />WORKERS COMPENSATION: <br />-Waiver of Subrogation <br />**Coverage per Statute includes:NC,SC,DC,GA,IN,KY,MD,TN,VA <br />UMBRELLA LIABILITY: <br />-Follow Form of Underlying General Liability,Automobile Liability and Workers Compensation policies <br />-Follow Form of Additional Insureds,Primary and Non-Contributory Basis,Waiver of Subrogation <br />-Per Project Aggregate Limit $5M /$10M Cap <br />-Per Location Aggregate Limit $5M /$10M Cap <br />EXCESS LIABILITY: <br />-Follow Form of North River's Umbrella Liability Policy <br />GENERAL: <br />-30 Day Third Party Notice of Cancellation [10 days for Non Payment of Premium]will be provided to all Certificate Holders as required by written contract for all <br />lines of coverage. <br />-XCU/EIFS:There are no exclusions for XCU and EIFS <br />-Residential Construction:There is no exclusion for Residential Construction under either the General Liability,Umbrella Liability or Excess Liability policies. <br />FORMS ATTACHED. <br />Orange County,its officers,official agents and employees are included as Additional Insured under the General Liability,Umbrella Liability and Automobile <br />Liability policies as required by written contract.A Waiver of Subrogation under the Workers Compensation applies in favor of the Additional Insured for work <br />performed by the insured if required by written contract for the referenced job and/or contract.Per the cancellation clause contained in the policies noted on this <br />certificate,the policy provisions include at least 30 days written notice of cancellation except for non-payment of premium. <br />Docusign Envelope ID: B61CE74E-980D-45EA-B9F9-C4F195E3CFD2