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AC RO EP <br />i._._r' <br />AGENCY CUSTOMER ID: CN101348564 <br />LOC #: Los Angeles <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />Marsh Risk & Insurance Services0 <br />NAMED INSURED <br />AECOMI <br />1999 Avenue of the Stars, Suite 2600u <br />LOS Angeles, QA 90667 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />m <br />m <br />Workers CompensationlEmployer Liability conLi <br />0 <br />Policy Number Insurer <br />WLR 064788759 Indemnity Insurance Company of North America - NAIC # 43575 <br />WLR C64788723 ACE American Insurance Company - NAIC # 22667 <br />SCF C64788747 ACE American Insurance Company - NAIC # 22667 <br />WCU C64788802 ACE American Insurance Company - NAIC #22667 <br />States Covered? <br />AOSI <br />CA and MAI <br />WI Retro? <br />OK Ohio Qualified Self Insured (QSI)- SIR: $500,000; Only applicable to specific quallfedu <br />entities self-insured in the state of Older <br />ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />