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AGENCY CUSTOMER ID: HUITTZOL LOC #: ACORO� AIIIIITI[1MA1 REMARKS Srl4l=nl II F AGENCY NAMED INSURED MHBT, a Marsh & McLennan Agency, LLC company Huitt-Zollars, Inc. 1717 McKinney Ave., Ste. 1400 POLICY NUMBER Dallas TX 75202-1236 CARRIER I NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Paae 1 of 1 r of subrogation form #WC00 edition 03/13 and #WC04 edition 03/06 and #WC42030413 applies to the Workers Compensation policy. nal Insured form #XL0003 edition 09/16 applies to the Umbrella policy. Notice of Cancellation form #I1-10307 edition 6/11 applies to the General Liability policy. Notice of Cancellation form #WC99 edition 03/94 and #WC990531 applies to the Workers Compensation policy Notice of Cancellation form #I1-10307 edition 06/11 applies to the Umbrella Liability policy. Notice of Cancellation form #I1-10307 edition 06/11 applies to the Auto policy. The General Liability policy contains language that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability policy contains an endorsement with "Primary and NonContributory" wording that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The General Liability policy contains a blanket waiver of subrogation endorsement that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The Automobile Liability policy contains language that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. e Automobile liability policy includes waiver of subrogation wording that may apply only when there is a written contract between the named insured and the rtificate holder that requires such wording. e Auto Liability policy contains an endorsement with "Primary and NonContributory" wording that may apply only when there is a written contract between the med insured and the certificate holder that requires such wording. e Worker's Compensation policy includes a waiver of subrogation endorsement that may apply only when there is a written contract between the named ;ured and the certificate holder that requires such wording. e Umbrella policy includes a blanket additional insured endorsement to the certificate holder only when there is a written contract between the named insured d the certificate holder that requires such status. e General Liability, Auto, Worker's Compensation and Umbrella liability policies includes a blanket notice of cancellation to the certificate holder endorsement, raiding for (30) days' advance written notice if the policy is canceled by the company, or 10 days' written notice before the policy is canceled for nonpayment premium. Notice is sent to certificate holders with mailing addresses on file with the agent or the company. The endorsement does not provide for notice of ncellation to the certificate holder if the named insured requests cancellation. ACORD 101 (2008/01) © 2008 ACORD The ACORD name and logo are registered marks of ACORD HORaN Risk Mwag merdDiAsian REVIEWED & APPROVED BY: o z P1. M44441 Risk Management Analyst