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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 />XTRALIGHTM <br />1 1 <br />Bowen,Miclette &Britt Insurance Agency,LLC Xtralight Manufacturing,Ltd <br />8812 Frey Rd <br />Houston,TX 77034 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />Blanket primary/non-contributory per form #RSG 7268 01/23 <br />*The Designated Project general aggregate limit is capped at $5,000,000 policy aggregate. <br />Automobile Liability: <br />Blanket additional insured per form #BA 30 00 12 15 <br />Blanket waiver of subrogation per form #BA 30 00 12 15 <br />Blanket primary/non-contributory per form #CA 04 49 11 16 <br />Worker’s Compensation: <br />Blanket waiver of subrogation per form #WC420304B <br />Umbrella: <br />Blanket additional insured per form #EXU0001 05/16 <br />Blanket waiver of subrogation per form #EXU0001 05/16 <br />Blanket primary/non-contributory per form #EXU0001 05/16 <br />Certificate Holder Includes:Orange County,its officers,agents and employees. <br />Docusign Envelope ID: 73815A84-8F24-48F3-87F6-02EE804F8E44