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AGENCY CUSTOMER ID: 645175
<br />LOC#:
<br />A? ADDITIONAL REMARKS SCHEDULE
<br />Paged of 2
<br />AGENCY NAMED INSURED
<br /> URS Corporation dba URS Corporation Americas
<br />Willis Insurance Services of California, Inc. 600 Montgomery Street, 26th Floor
<br />POLICY NUMBER San Francisco, CA 94111
<br />See First Page
<br />CARRIER NAIC CODE
<br />See First Page EFFECTIVEDATE: See First Page
<br />MVVI I IV IVfiL. nr_1V1Mn F%J
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
<br />Workers Compensation policies apply as indicated below:
<br />WC20635051 - CA
<br />WC20635052 - FL
<br />WC20635053 - TX
<br />WC20635054 - AK, AL, AZ, DC, DE, HI, IA, IL, IN, KS, LA, MD, ME, MI, MO, MS, MT, NC, NE, NH, NJ,
<br />NM, OK, PA, RI, SC, SD, TN, VA, VT
<br />WC20635055 - AR, CO, CT, GA, ID, KY, MA, MN, ND, NV, NY, OH, OR, UT, WA, WI, WV, WY
<br />Severability of Interest applies.
<br />Santa Ana Public Works Agency is Additional Insured with respect operations performed by or for
<br />the Named Insured as respects General Liability.
<br />1.V-jz-L01j0 lp1:11771o,& uerz:15LUbUUU (92oo8ACORDCORPORATION. Allrights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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