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Docusign Envelope ID:230C4AAA-8F3E-805F-8375-AC27622853D5 <br /> ­--i AGENCY CUSTOMER ID: <br /> Ac "� LOC#: <br /> ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMEDINSURED <br /> FEDERATED MUTUAL INSURANCE COMPANY HARRIS BROTHERS ELECTRIC AND CONTROLS,INC. <br /> 2712 HILLSBOROUGH RD <br /> POLICY NUMBER DURHAM,NC 27705-4044 <br /> SEE CERTIFICATE#305.1 <br /> CARRIER NAIC CODE EFFECTIVE DATE:SEE CERTIFICATE#305.1 <br /> SEE CERTIFICATE#305.1 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br /> SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY, ADDITIONAL INSUREDS ALSO INCLUDES ORANGE COUNTY, ITS OFFICERS, <br /> OFFICIAL AGENTS AND EMPLOYEES. <br /> SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY, WAIVER OF SUBROGATION ALSO INCLUDES ORANGE COUNTY, ITS <br /> OFFICERS, OFFICIAL AGENTS AND EMPLOYEES. <br /> THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, <br /> LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT <br /> FOR GENERAL LIABILITY. <br /> THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT <br /> ENDORSEMENT FOR BUSINESS AUTO LIABILITY. <br /> WORKERS COMPENSATION CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER WHERE PERMITTED BY STATE <br /> STATUTE SUBJECT TO THE CONDITIONS OF THE WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT. <br /> COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL <br /> UMBRELLA POLICY. <br /> FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE <br /> EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. <br /> ACORD 101 (2008/01) O 2008 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />