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<br />AGENCY CUSTOMER ID: 838732
<br />LOC#: Boston
<br />ADDITIONAL REMARKS SCHEDULE
<br />Page 2 of 2
<br />AGENCY
<br />MARSH USA INC,
<br />NAMEOINSUReG
<br />TELVENT USA, LLC
<br />1390 PICCARD DRIVE, SUITE 200
<br />ROCKVILLE, MD 20850
<br />POLICYNUMSER
<br />CARRIER
<br />NAIC COVE
<br />EFFECTIVE DATE:
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORO FORM,
<br />FORM NUMBER: Gb FORM
<br />ADDITIONAL NAMED INSUREDS INCLUDES THE FOLLOWING:
<br />Telvent Parradyne Engineering, P.C.
<br />Telvent SeMces, Inc,
<br />ADDITIONAL WORKER'S COMP POLICIES: 01101/15.01,01116
<br />Policy Numbers are an follows:
<br />WC 011853043 (AL, AR, CO, CT, DG, DE, GA,111, IA, 10, IN, KS, LA, MD, MI, MO, MS, MT, NE, NM, NV, NY, OK, OR, RI, SC, S0, TN, TX, WV)- New Hampshire Insurance Company
<br />WC 011953044 (CA)- Now Hampshire Insurance Company
<br />WO 0119530345 (FL) - NOW Hampshire Insurance Company
<br />WC 011053047 (MA,NO,OH, WA,WI,WY) � New Hampshire Insurance Company
<br />WC 011953046 (MN) New Hampshire Insurance Company
<br />'NC 011 953048 FL, KY, NO, NH, UT, Vr) New Hanpahirs Insurance Company
<br />WC 011953049 (NJ, PA) Now Hampshire Insurance Company
<br />WC 011953050 (ME) New Hampshire Insurance Company
<br />WC 011953051 (AZ, VA) New Hampshire Insurance COmperry
<br />PUERTO RICO: WC IS PURCHASED THROUGH THE STATE FUND AS PUERTO RICO IS MONOPOLISTIC.
<br />OHIO ONLY EXCESS WORKERS COMP: 0110111 5-0 110117 6
<br />9883923 - National Union Fire Insurance Company
<br />EACH ACCIDENT: $3,000,000
<br />DISEASE -POLICY LIMIT: $3,000,000
<br />DISEASE -EACH EMPLOYEE: $3,000,000
<br />SELF-INSURED RETENTION: $2,000,000
<br />Telvent USA, LLC has agreed that, within 30 days after raCelpl of notice of cancrurnion of Ilia Insurance policies referenced above from the applicable Insurers, Telvent USA, LLC or Its designee will send a copy of such
<br />force to the Oenlllcate Molder of this Cerhroete. Such notice Is not a III or obligation within the policies, it does not alter or amend any coverage, it wlll not extend any policy oencellalion date and it will not negate any
<br />08nee0811011 of ins 0011ey. Failure to provide a copy of such notice to the Coniflcate Holder shall Imposa no obligation or liability of any II upon the Insurer or IIs agents or representatives,
<br />VENT USA, LLC AGREEMENT # A-2013-018 REVIEWED BY:
<br />A. EUNICE HEREDIA (PG. 2 Of 8)
<br />ACORD 101
<br />© 2008 ACORD CORPORATION. All rights
<br />The ACORD name and logo are registered marks of ACORD
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