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AGENCY CUSTOMER ID: CN103150778 <br />LOC #: St. Louis <br />ADDITIONAL REMARKS SCHEDULE <br />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 />P <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: 25 FORM TITLE: Certificate of Liability Insurance <br />Excess Workers' Compensation -MWXS 313639 21 (OH -WA) <br />Self Insured Retentions <br />Of & WA - $500,000,000 (except Terrorism) <br />ON & WA - $600,000,000 Terrorism <br />RPele vivagemed Divlatm <br />y I ECG REMM'En6APPRom By., <br />ACORD 101 (2008101) o) 2nnR ArnRn r. <br />Risk Management Analyst <br />The ACORD name and logo are registered marks of ACORD <br />