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AGENCY CUSTOMER ID: 645175
<br />LOC#:
<br />ADDITIONAL REMARKS SCHEDULE Paves 2 of 2
<br />AGENCY
<br />NAMED INSURED
<br />Wi11ia Insurance, Services of California, Inc.
<br />URS Corporation
<br />2020 E. First
<br />Santa Ana, CA
<br />dba URS Corporation Americas
<br />Straat, Suite 400
<br />92705
<br />POLICY NUMBER
<br />See First Paga
<br />CARRIER
<br />NAIL CODE
<br />See Firat: P8 e,
<br />EFFECTIVE DATE: Sea
<br />F1rat. page,
<br />ADDITIONAL REMARKS
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMRFR- 25 FnRM TITI F• CERTIFICATE OF LIABILITY INSURANCE
<br />Workers Compensation policies apply as indicated helow:
<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, Na,
<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, ite o£Eicars, employees, agent&, volunteers and raprasantativea ara includad
<br />as Additional Insureds as respects tha Gana -al Liability c policy, where required by written contract
<br />Thia in&uraaca is Primary over any &imilar insurance available to any person or organization we,
<br />have added to this policy as Additional Insureds.
<br />ACORD IOC (2008/01) Co11:3376174 Tp1:1261289 Cart:16028973 ©2008 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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