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ACORO® <br />Li <br />AGENCY CUSTOMER ID: CN103150778 <br />LOC #: St. Louis <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMEDINSURED <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 />- <br />CARRIER <br />NAIL CODE <br />EFFECTIVE GATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Instil <br />Excess WorkersCompensation-MWXS 31363921 (OH -WA) <br />Sell Insured Retentions <br />OH & WA - $600,000,000 (except Terrorism) <br />ON & WA - $600,000.000 Terrorism <br />y s ffEvovE®&APPRovED BY: <br />ACORD 101 (2008101) © 2008 ACORD C � r�ma <br />The ACORD name and logo are registered marks of ACORD Risk MaDagemenS Analyst <br />