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ACCIROi <br />hw/ <br />AGENCY CUSTOMER ID: CN103150778 <br />LOCO: St. Louis <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMEDINSURED <br />Marsh USA Inc <br />New Cingular Wineless PCS, LLC <br />One AT&T Plaza <br />208 South Akard <br />POLICY NUMBER <br />Room 1820 <br />Dallas, TX 75202 <br />CARRIER <br />NAIC CODE <br />EFFECTNE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: <br />Certificate of Liability Insurance <br />Excess Womers Compensation -MWXS 31363920 (011-WA) <br />Sell Insured Retentions <br />OH S WA - 5500,000,000 (except 7eeonsm) <br />OHS WA $600,000,000 Temnsm <br />Excess Automobie LiBNMy - MWZX 313637201MI) <br />Combined Single Unit- S1,000,000 <br />Sell Insured Retention - $1,000.000 <br />REVIEWED & APPROVED <br />By Risk MANA(lEMENT DIVISION <br />JULA 1 2020 <br />ANGiE ACEVFdo <br />ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />