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AGENCY CUSTOMER ID: <br />LOC #: <br />a ocRH ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />PRODUCER <br />MCGRIFF, SEIBELS & WILLIAMS OF GEORGIA, INC. <br />INSURED <br />Kelly Services Inc. and it's Subsidiaries <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />ISSUE DATE: 10/31/2017 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: FORM TITLE: <br />Coverage - Excess Workers Compensation <br />Carrier - ACE American Insurance Company (NAIL Code 22667) <br />Policy # - WCUC49109027 <br />Term - 1/1/2017 - 1/1/2018 <br />Limits - <br />Each Accident $1,000,000 <br />Disease Policy Limit $1,000,000 <br />Disease Each Employee $1,000,000 <br />Coverage - Retro Workers Compensation <br />Carrier - ACE Fire Underwriters Insurance Company (NAIC Code 20702) <br />Policy ff - SCFC49108941 <br />Term - 1/1/2017 - 1/1/2018 <br />Limits - <br />Each Accident $1,000,000 <br />Disease Policy Limit $1,000,000 <br />Disease Each Employee $1,000,000 <br />REVIEWED LM, r4L @Qj ) <br />By Margaret Mercer at 2:53 pre, Nov 07, 2017 <br />2008 ACORD CORPORATION. All rislhts resery <br />The ACORD name and logo are registered marks of ACORD CERTIFICATE NUMBER: SYK4KW96 <br />