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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 />Convergint Technologies LLC #446 <br />Location #446 <br />One Commerce Drive <br />Schaumburg, IL 60173 <br />Orange County, its officers, agents and employees are included as Additional Insureds as respects to General Liability <br />as required by written contract. <br />A Waiver of Subrogation in favor of Additional Insureds applies to the Workers Compensation policies where required by <br />written contract as permitted by law. <br />INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC#: 22667 <br />POLICY NUMBER: WLR C73097356 EFF DATE: 04/01/2025 EXP DATE: 04/01/2026 <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 (AZ) E.L. Disease Pol Lmt $1,000,000 <br />Per Statute E.L. Disease EA Empl $1,000,000 <br />INSURER AFFORDING COVERAGE: Lexington Insurance Company NAIC#: 19437 <br />POLICY NUMBER: 06-343-89-23 EFF DATE: 04/01/2025 EXP DATE: 04/01/2026 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Cyber Aggregate $5,000,000 <br /> Occurrence $5,000,000 <br />INSURER AFFORDING COVERAGE: Lexington Insurance Company NAIC#: 19437 <br />POLICY NUMBER: 015136526 EFF DATE: 04/01/2025 EXP DATE: 04/01/2026 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Pollution Liability Per Occurrence $5,000,000 <br />Non-Owned Disposal Sites Aggregate $5,000,000 <br />2 3 <br />Willis Towers Watson Midwest, Inc. <br />See Page 1 <br />See Page 1 See Page 1 See Page 1 <br />25 Certificate of Liability Insurance <br />W39330245CERT:3998313BATCH:27904855SR ID: <br />Docusign Envelope ID: 72FC414F-3F71-425A-8BE7-8ACB88B3ED15