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ACORO® <br />L i <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 />Gallas, TX 75202 <br />CARRIER <br />NAILJCODE <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 31363921 (OH -WA) <br />Self Insured Retentions <br />OH & WA - S500,000.000 (except Terrorism) <br />OH & WA - $600,000.000 Terrorism <br />(2008/01) © 2008 ACORD C R, vLCGco d <br />The ACORD name and logo are registered marks of ACORD Rifk Management Anaysr <br />