Discussion and Consideration of Pay Application #8 – Miron Construction – Tiffin Recreation Center – Motion to Approve — K-2

AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, LLC Consolidated Electrical Distributors, Inc. 1920 Westridge Dr POLICY NUMBER Irving TX 75038-2901 B1262SM0884724 CARRIER NAIC CODE Underwriters at Lloyd's, London 32727 EFFECTIVE DATE: 11/01/2024 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 28 FORM TITLE: EVIDENCE OF COMMERCIAL PROPERTY INSURANCE REMARKS: Certificate holder is an additional insured and loss payee as their interests may appear for up to $75,000,000 of customer inventory, unless higher limits are specifically endorsed. Additional Insured: Miron and City of Tiffin LOCATION/DESCRIPTION: Job/Project Name: Tiffin Recreation Center Material: Lighting ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD