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ACORD 101 (2014/01)© 2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />AGENCY CUSTOMER ID: <br />LOC# : <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />AFFIRMATIVE INSURANCE SERVICES INC <br />NAMED INSURED <br />TANNER VALUATION GROUP, LLC JAMES D. TANNER <br />405 SPRING ST <br />CHERRYVILLE NC 28021-3538 <br />POLICY NUMBER <br />SEE ACORD 25 <br />CARRIER <br />SEE ACORD 25 <br />NAIC CODE <br />EFFECTIVE DATE:SEE ACORD 25 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER:ACORD 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE <br />Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others <br />Endorsement WC000313, attached to this policy. Certificate holder is an additional insured per the Business Liability Coverage <br />Form SS0008, attached to this policy. RE:Policy Location for Employees Performing Job (Work Comp): 702 E MAIN ST, <br />CHERRYVILLE, NC 28021-3419 Payroll for job to support waiver (Work Comp): 93,600 Do we need to add this amount to the <br />estimated payroll on the policy (Work Comp)?: No <br />Docusign Envelope ID: 267ECFE9-0243-4926-8FEA-9E6D6EBB3DDB