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ACORO® <br />`� <br />AGENCY CUSTOMER ID: CN103150778 <br />LOC #: St. Louis <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of <br />AGENCY <br />NAMED INSURED <br />Marsh USA Inc. <br />New Cingular Wireless 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 />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: L5 FORM TITLE: <br />Excess Workers' Compensation -MWXS 313639 21 (OH -WA) <br />Sell Insured Retentions <br />OH & WA-$500,000,000 (except Terrorism) <br />OH & WA-$600000,000 Tercrism <br />REmEwED & APPROVED 8Y: <br />ACORD 101 (2008/01) © 2008 ACORD Ci I sl a7 (-`� ,� PZ. vs-" wj <br />The ACORD name and logo are registered marks of ACORD '=�—MJFM Risk Management Analyst <br />