Declaration of Contractual Relationship (DCR)

(“Supplier”) hereby acknowledges and represents as follows:

Supplier has entered or plans to enter into a contractual agreement (the “Agreement”) to provide goods and/or services to Cook Group, Inc. ("Cook"). As a condition of providing goods and/or services under the current or anticipated Agreement, Cook requires that their agent, Global Risk Management Solutions (“GRMS”), be provided valid evidence of insurance naming Cook Group, Inc. and the applicable customer as Additional Insured on supplier’s Comprehensive General Liability policy. Cook Group, Inc. c/o Global Risk Management Solutions shall be specified as the Certificate Holder of said policies and shall be entitled to a 30-day notification of any material changes or cancellations.

The format for the Additional Insured language shall be substantially as follows:

“Any person or organization whom you are required to add are included as an Additional Insureds on the General andAutomobile Liability policies with a Waiver of Subrogation on General, Automobile and Workers Compensation policies under a written contact or written agreement.”

Insurance coverage must remain current and any lapse in coverage may result in not receiving an Agreement or the termination of the Agreement.

[Rev. 2020]