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A C"R O <br />L <br />AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />ACENCY <br />NAMEDINSURED <br />Parrilli, David <br />Green Demolition Contractors, Inc <br />POLICY NUMBER <br />See Prior Page <br />CARRIER <br />NAIL CDDE <br />See Prior Page <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 <br />Re: Taureaux Tavern - 155 W. Van Buren St - Chicago, IL 60605 <br />Additional insureds when required by written contract on a primary & non-contributory basis with respect to <br />General Liability, Aired & Non Owned Auto Liability (Umbrella follows form) for work performed by Green Demolition <br />Contractors, Inc. per ISO Forms CG 2010 10/01 and CG 2037 10/01 (attached); A Waiver of Subrogation in favor of <br />Additional Insureds with regard to General Liability, Hired & Non Owned Auto Liability (Umbrella follows form) is <br />included when required by written contract per ISO Form CG 2404 (05/09) (attached): <br />-I.G Construction Group, LLC (General Contractor) <br />•Taureaux Tavern, LLC (Owner) <br />-.7onatahan Splitt Architects Ltd (Architect of Record) <br />And LG Construction's peripheral parties, including: LG Development Group LLC, Goldberg Development Group LLC, ML <br />Development Group LLC, and Cuda Development LLC." <br />ACORD 101 (2008/01) a 2008 ACORD CORPORATION. All rights reserved. <br />INS101 {200e01) The ACORD name and logo are registered marks of ACORD <br />