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AGENCY CUSTOMER ID: <br /> LOC#: <br /> ACORD ADDITIONAL REMARKS SCHEDULE Page of <br /> AGENCY NAMED INSURED <br /> Scott&McCauley Insurance Agency EBS GENERAL ENGINEERING,INC <br /> POLICY NUMBER <br /> CARRIER NAIC CODE <br /> EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes <br /> COVERAGE PROVIDED PER THE FOLLOWING COVERAGE FORMS: <br /> GL-CNA75079XX(10-16)-Blanket Additional Insured-Owners,Lessees or Contractors-with Products-Completed Operations Coverage Endorsement <br /> GL-CNA74705XX(1-15)-Additional Insured-Primary And Non-Contributory To Additional Insured's Insurance <br /> GL-CNA74705XX(1-15)-General Aggregate Limits of Insurance-Per Project <br /> GL-CNA74705XX(1-15)-Waiver of Subrogation-Blanket <br /> Auto-CNA63359XX(04-12)-Blanket Additional Insured when required by written contract <br /> Auto-CNA63359XX(04-12)-Additional Insured-Primary And Non-Contributory To Additional Insured's Insurance <br /> Auto-CNA63359XX(04-12)-Blanket Waiver Of Subrogation when required by written contract <br /> WC-G-19160-B-WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br /> `UMBRELLA IS FOLLOW-FORM* <br /> RiskManagementDivision <br /> , REVIEWED&APPROVED BY: <br /> ���,s <br /> '1htiWIIP. AlAccuuto <br /> ' Risk Management Specialist <br /> ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />