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FORM NUMBER: <br />EFFECTIVE DATE: <br />The ACORD name and logo are registered marks of ACORD <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE <br />FORM TITLE: <br />Page of <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />ACORD 101 (2008/01) <br />AGENCY CUSTOMER ID: <br />AGENCY NAMED INSURED <br />POLICY NUMBER <br />CARRIER NAIC CODE <br />© 2008 ACORD CORPORATION. All rights reserved. <br />Diversified Insurance <br />BROWBRO-02 <br />SEE PAGE 1 <br />1 <br />SEE PAGE 1 <br />ACORD 25 Certificate of Liability Insurance <br />SEE P 1 <br />Brown Brothers Plumbing and <br />Heating Company, Inc. <br />2820 N. Roxboro Road <br />Durham, NC 27704 <br />SEE PAGE 1 <br />1 <br />The following forms apply if required by written/executed contract, before loss: <br />Additional Insured for General Liability Ongoing & Completed Operations and Primary & Non-contributory wording: CG7034(07/09), <br />CG7024(03/09) and CG2001(4/13). <br />Blanket Additional Insured applies to Contractors Pollution Liability for Ongoing & Completed Operations, when required by written <br />contract. <br />Designated Insured for Auto Liability: CA2048(10/13). <br />Blanket Waiver of Subrogation for General Liability: CG7051(06/15). <br />Blanket Waiver of Subrogation for Workers Compensation: WC 000313(04/84). <br />Blanket Waiver of Subrogation for Contractors Pollution Liability. <br />Contractors Pollution Liability: Aggregate $5,000,000 Self-Insured <br />Retention $2,500. Contractors Pollution Liability: Includes Mold Liability at $5,000,000 limit. Contractors Pollution Liability: Mold <br />deductible $2,500. <br />Blanket Additional Insured on Automobile Liability, with Primary and non-contributory wording, per attached form CA3000(07/14). <br />Umbrella follows form for General Liability, Automobile Liability and Workers Compensation. <br />**Contractors Rented/Leased Equipment is $250,000 subject to a $1,000 Deductible. Effective 12/31/2025 to 12/31/2026 under policy <br />number PCP000005517** <br />Docusign Envelope ID: AC1CD288-4733-4BAB-B895-FE5CCF37576B