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<br />AGENCY CUSTOMER ID: _838732
<br />LOC fy: Boston
<br />ADDITIONAL REMARKS SCHEDULE
<br />Page 2 of 3
<br />AGENCY
<br />NAMED INSURED
<br />MARSH USA INC,
<br />Schneider Electric Holdings, Inc.
<br />(See page 2 for Additional Named Insureds)
<br />200 North Martingale Road, Suite 1000
<br />POLICY NUMBER
<br />Schaumburg, IL 00173
<br />CARRIER
<br />NAIC CODE
<br />EFFECTIVE DATE;
<br />A V V I I IV IYAL INCIVIAMA0
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
<br />ADDITIONAL NAMED INSUREDS INCLUDE THE FOLLOWING:
<br />Schneider Electric IT Corporation
<br />Schneider Electric IT USA, Inc.
<br />AST North America, LLC
<br />Schneider Electric IT America Corp.
<br />GRC Energy Support Services, LLC
<br />Invonsys Systems, Ino.
<br />Invensys Systems, Inc., doe Schneider Electric Systems USA, Inc,
<br />Invensys Systems, Inc., doe Schneider Electric Systems USA
<br />Indusof6 Inc.
<br />InStep Sellware, LLC
<br />Schroder Electric IT Mission Critical Services, Inc.
<br />Pelco, Inc
<br />Pro Face America, LLC
<br />Schneider Electric Bulldings Americas, no
<br />Schneider Eleoluo Buildings Critical Systems, Ino.
<br />Schneider Electric Buildings, LLC
<br />Schneider Electric Power Services, Inc.
<br />Schneider Electric USA, Inc,
<br />Schnelder Electric Engineering Services, LLC
<br />Schneider Electric Motion USA, Inc.
<br />Schneider Electric Software, LLC
<br />Schneider Electric Solar Inverters. USA
<br />Summit Energy Services, Inc.
<br />Telvant USA, LLC
<br />Schneider Elocluo Mobility NA, Inc,
<br />I elvent DTN, LLC
<br />Voris Industries, LLC
<br />"ADDITIONAL WORKERS COMP POLICIES"
<br />CARRIER: NEW HAMPSHIRE INSURANCE COMPANY
<br />POLICY PERIOD: 01101116 - 01/01117
<br />POLICY NUMBERS AND STATES,
<br />WC 068022490 (AL, AR, CO, CT, DC, DE, GA, HI, IA, ID, IN, KS, LA, MD, MI, MO, MS, MT, NE, NM, NV, NY, OK, OR, RI, SC, ED, TN, TX, WV)
<br />WC 060022493 (CA)
<br />WC 060022498 (FL)
<br />WC 068022494 (MANgOH, WA,WI,WY)
<br />WC 060022491 (MN)
<br />WC 068022490 (IL, KY, NO, NH, UT, VT)
<br />WC 068022497 (NJ, PA)
<br />WC 068022492 (ME)
<br />WC 066022495 (AZ, VA)
<br />PUERTO RICO, WC IS PURCI LASED THROUGH THE STATE FUND AS PUERTO RICO IS MONOPOLISTIC,
<br />REVIEWED BY;c all e„, EUNICE HEREDIA (PG ZOF'�—)._..
<br />ACORD 101 11 8 ©2008 ACORD CORPORATION. All riahts reserved
<br />The ACORD name and logo are registered marks of ACORD
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