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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page of <br />AGENCY <br />NAMED INSURED <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: FORM TITLE: <br />THIRD PARTY CRIME/FIDELITY COVERAGE <br />Carrier: TRAVELERS CAS & SURETY CC OF AMER [A +,XV] NAIC #31194 Policy #: 1055812961 Effective: 04/01/2015 to 04/01/2016 I Limit: $500,000 <br />Aggregate limit for Employee Theft fo Client Property I Retention: $50,000 <br />PROPERTY COVERAGE <br />Carrier: LIBERTY MUTUAL FIRE INS CO /LIBERTY MUTUAL INSURANCE CO. [AM BEST: A,XV] NAIC #23035 Policy 4: YU2- 1-91-453980 -0651 <br />SFOMC10043106 I Effective: 04/01/2015 to 04/01/2016 Blanket Personal Property: $21,885,000 1 Instatlation - PP1PPo: $1,000.000 1 Transit: $250,000 <br />(Blanket Personal Property includes Personal Property of Others and Valuable Papers and records at insured locations). <br />GENERAL LIABILITY: <br />" Additional Insured if required by written contract per attached form LC0443 0512 <br />* Coverage is Primary & Non- Contributory if required by written contract perform LC0443 0512 <br />* Waiver of Subrogation if required by written contract per attached form LC0443 0512 <br />" Noticed of Cancellation if required by written contract per attached form LM9901 0511 <br />" Separation of Insureds applies per policy form. (Severability of Interest/Cross Liability Clause) <br />AUTOMOBILE LIABILITY: <br />Designated Insured if required bywritten contract per attached form CA2048 1 C13 <br />" Waiver of Subrogation if required by written Contract per attached form AC8407 0713 (All Other) <br />" Waiver of Subrogation if required by written contract per attached form AC8448 0613 (Florida) <br />Noticed of Cancellation if required by written contract per attached form LIM 99 01 05 11 <br />" Separation of Insureds applies per policy form. (Severability of Interest/Cross Liability Clause) <br />* CA9948 and MSC90 Endorsements included. <br />WORKERS' COMPENSATION: <br />• Waiver of Subrogation if required bywritten contract per attached form W004036 0484 (California) <br />• Waiver of Subrogation if required bywritten contract per attached form WC000313 484 (Other States) <br />• Waiver of Subrogation if required bywritten contract per attached form WC420304 1084 (Texas) <br />• Noticed of Cancellation if required by written contract per attached form WM9018 0611 <br />EXCESS LIABILITY: <br />* Underlying Policies: General Liability, Automobile Liability, and Employers' Liability <br />* Noticed of Cancellation if required by written contract per attached form LM9901 0511 <br />* Separation of Insureds applies per policy form. (Severability of Irterest/Cross Liability Clause) <br />ACORD 101 (2008101) <br />O 2008 ACORD CORPORA <br />The ACORD name and logo are registered marks of ACORD <br />