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AGENCY <br />Marsh USA Inc. <br />POLICY NUMBER <br />CARRIER <br />AGENCY CUSTOMER ID: CN103150778 <br />LOC #: St. Louis <br />ADDITIONAL REMARKS SCHEDULE <br />NAIC CODE <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insul <br />Excess Workers' Compensation 4WXS 31363920 (OH -WA) <br />Sell Insured Retentions <br />OH & WA - $500,000,000 (except Termnsm) <br />011 & WA-$600,000.000 Termrom <br />Excess Automobile Liability - MWZX 31363720 (MI) <br />Combined Single Limit -$1,00D,000 <br />Self Insured Retention -$1,000,000 <br />NAMED INSURED <br />New Cingular W reless PCS, LLC <br />One AT&T Plaza <br />208 South Akard <br />Room 1820 <br />Dallas, TX 75202 <br />EFFECTIVE DATE: <br />Page 2 of 2 <br />I�NE�[4D 4 APrRaAD BY: <br />101 (2008I01) 92008 ACORD Ci 1 fK� v:Uit4a� <br />The ACORD name and logo are registered marks of ACORD +W aasageMexr N+Mpl <br />