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AGENCY CUSTOMER ID: CN103150778 <br />_ LOC #: St. Louis <br />A� ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <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: LO FORM TITLE: <br />Excess Workers' Compensation -MWXS 313639 21 (OH -WA) <br />Sell Insured Retenfions <br />OH & WA - $500.000,000 (except Tenonsm) <br />OH & WA - $600,000,000 Terrorism <br />t ^uwBnma armlet ' <br />REtnEvum& APPRov® ar sT <br />ACORD 101 (2008101) © 2008 ACORD C 9l . n F M-4r a Z Vj&'Al[ <br />The ACORD name and logo are registered marks of ACORD I =�—ww' Rok Management Analyst <br />