|
AGENCY CUSTOMER ID: URSCOR
<br />LOC #: San Francisco
<br />Aco ADDITIONAL REMARKS SCHEDULE
<br />Page 2 of 2
<br />AGENCY
<br />NAMED INSURED
<br />MARSH RISK & INSURANCE SERVICES
<br />URS Corporation
<br />dba URS Corporation Americas
<br />2020 E. First Street, Suite 400
<br />POLICY NUMBER
<br />Santa Ana, CA 92705
<br />CARRIER
<br />NAIC CODE
<br />EFFECTIVE DATE:
<br />ADDITIONAL REMARKS
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
<br />The Workers' Compensation coverage shown does not apply in monopolistic states. In the States of ND, OH, WA and WY Workers' Compensation coverage is provided by the Slate Fund. In those States, the above -
<br />referenced policies provide Stop -Gap Employers' Liability only. Workers Compensation policies apply as indicated below:
<br />Insurer A: National Union Fire Ins Cc Pittsburgh, PA NAIC# 19445100
<br />WCO21417576 -CA
<br />Insurer D: Insurance Company Of The State Of PA NAIC# 19429100
<br />WC 021417580 - MA, WI (Stop Gap - ND, OH, WA, WY)
<br />WC 021417581 - AK, AL, AR, AZ, CO, DE, GA, ID, KS, KY, MD, ME, MO, MS, MT, NC, NH, NM, NV, OK, OR, PA, RI, SC, SD, TN, UT, VA, VT, WV
<br />WC 021417585 - MN
<br />WC 021417578 - NY
<br />Insurer C: Illinois National Ins Co NAIC# 23817001
<br />WC 021417577 - FL
<br />WC 021417582 - CT, DC, HI, IA, IL, IN, LA, MI, NE, NJ
<br />WC 021417579 - TX
<br />,R%,UMU IV I j/UUarU-I) © 2008 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|