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ACC?RO® <br />t_ __..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 Serviceso <br />NAMED INSURED <br />AECOMo <br />1999 Avenue of the Stars, Suite 2600u <br />Los Angeles, QA 90067 <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 Compensation/Employer Liability conU <br />0 <br />Policy Number Insurer <br />WLR 064708759 Indemnity Insurance Company of North America - NAIC # 43575 <br />WLR C64788723 ACE American Insurance Company - NAIC # 22667 <br />SCF C64780747 ACE American Insurance Company - NAIC # 22667 <br />WCU 064788802 ACE American Insurance Company - NAIC # 22667 <br />Stales Covered 0 <br />AOSu <br />CA and MAD <br />WI RetroD <br />ON, Ohio Qualified Self Insured (OSI) -SIR: $500,000; Only applicable to specific qualified; <br />entities self-insured in the state of Ohiom <br />© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />