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A#C40119" <br />. ... . ... .. <br />�,=:Y',�Wnce Agency <br />POLEYWL"Aam <br />CARMER <br />AGENCY CUSTOMER 10: <br />LOC 0: <br />ADDITIONAL REMARKS SCHEDULE <br />........ . ..... . ... .. .. . J, <br />11...1 .1. <br />i� �Mm 1 1111111111 . . ....... .... ........ .,. <br />..... ..... . <br />Rictord Drake Construdion Company, LP <br />MAIC CODS <br />page of <br />ADDITIONAL REMARKS <br />1111-11.11 . . . . .. . - . . . ...... .. ..... . <br />THIS ADDMOKAL REMARKS FORM IS A SCHEDULE TOACORD FORM, <br />FORM NUMBER: 215 FORM TITLE: Catfi:ate of LWAIV himurarAw. Notes <br />`... ......... . <br />The <br />Geners"I'Ll'iblity and Auto Liability polloles Include a blanket aulcimalc additionalInsured endorsement that provides additional Inwred statue do the <br />owtifiaste holder only when there Is a wAhn wiftet between the named Insured and the ceNfroabe holderW requIres suah slates. The General WAft <br />and Auto policles RiducleAddlikinal Insured - Lawr of Leased Equipment - Automatic Status when RequIred In Lem Agreement with You endonmmmte, <br />'The General LW ft endomements wording Includes bolh the Insureds Onoft and Ompleted Coelatfons. <br />The General Liablifty andAuto Liablilly polldes corrialn an enElorsernent wAth 'Pdmry and NainowWbutory' wording. <br />The General Uablifty, Auto Liability and lAbrkers' Compensaft policies Include blanket autornalic waiver of subrogation endorsements that pRmde this <br />Mature, ordy When there Is a written contract babNeen the named Insured and the cartillmde holder that reWreg IL <br />CONTROW"MRS EQUIPMENT <br />Blanket Low Payee Endorsement Form IM441-IM 050. <br />X11 WAYS REFER TO THEA*rTACHED POLICY FORMS FOR SPECIFIC WORDING OF SUCH COVERAGE, LWS, CONDITIONS AND EXCLUSIONS. <br />........ . ... .. ...... ..... .. ..... . .. .. ........ .... ..... . ... . ......... <br />ACORD 101 1200WII) V 2008 ACORD CORPORATION. AR righlB reserved. <br />Tho Arnnn name and Irinei ora raninfered marks of ACORD <br />