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AGENCY CUSTOMER ID: 645175
<br />LOC#:
<br />A� ADDITIONAL REMARKS SCHEDULE Page 9 of 2
<br />AGENCY
<br />Willis Insurance Services of California, In_c.
<br />POLICY NUMBER
<br />See First
<br />CARRIER
<br />See First
<br />NAIC CODE
<br />NAMED INSURED
<br />URS Corporation dba URS Corporation Americas
<br />2020 E. First Street, Suite 400
<br />Santa Ana, CA 92705
<br />EFFECTIVE DATE: See First
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
<br />lWorkere 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 />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included
<br />as Additional Insureds as respects the General Liability policy, where required by written contract
<br />This insurance is Primary over any similar insurance available to any person or organization we
<br />have added to this policy as Additional Insureds.
<br />ACORD101 (2008/01) Coll:3376174 Tpl:1261289 Cert:16028973©2008ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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