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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 />UTILITYMET <br />1 1 <br />Bowen,Miclette &Britt Insurance Agency,LLC Utility Metering Solutions,LLC <br />211 E.Thomas St. <br />Hammond LA 70401 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance.The terms contained in <br />the policies and/or endorsements supersede the representations made herein.Electronic copies of the policy provisions and/or endorsements listed below are <br />available by emailing Contact Person shown above. <br />General Liability: <br />Blanket additional insured Ongoing Operations per form #CG 20 10 04 13 <br />Blanket additional insured Completed Operations per form #CG 20 37 04 13 <br />Blanket waiver of subrogation per form #CG 24 04 05 09 <br />Blanket primary/non-contributory per form #CG 20 01 04 13 <br />Automobile: <br />Blanket additional insured per form #CA 20 48 10 13 <br />Blanket waiver of subrogation per form #AC 84 90 11 17 <br />Blanket primary/non-contributory per form #AC 84 23 08 11 <br />Worker’s Compensation: <br />Blanket waiver of subrogation per form #WC 42 03 04 B <br />Blanket alternate employer per form #WC 00 03 01 04/84 (TX);WC 00 03 01 A 02/89 (Other States) <br />Umbrella: <br />Blanket additional insured per form #CNA75504XX 03/15 <br />Blanket waiver of subrogation per form #CNA75504XX 03/15 <br />Blanket primary/non-contributory per form #CNA75504XX 03/15 <br />2nd Layer Excess Liability: <br />Blanket additional insured per form #MAUB 0001 01 15 <br />Blanket waiver of subrogation per form #MAUB 0001 01 15 <br />Blanket primary/non-contributory per form #MAUB 1512 04 17 <br />Docusign Envelope ID: 1F8C46CD-1FC1-48D6-A0AD-DEE659D008C4