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AGENCY CUSTOMER ID: URSCOR
<br />LOC #: San Francisco
<br />AC40
<br />L___
<br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2
<br />AGENCY
<br />MARSH RISK & INSURANCE SERVICES NAMED INSURED
<br />URS Corporation
<br />600 Montgomery Street
<br />26th Floor
<br />POLICY NUMBER ,
<br />San Francisco, CA 94111
<br />CARRIER 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 />The Workers' Cornpernaiion coverage shown does not apply in monopolistic states. In the States of ND, OH, WA and WY Workers' Compensation coverage is provided by the State 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 />WC 021417576 -CA
<br />WC 021417579 - TX
<br />Insurer 0: Insurance Company Of The State Of PA NAIC# 19429100
<br />WC 021417580 - MA, WI (Stop Gap)
<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 />Insurer C: Illinois National Ins Co NAIC# 23817001
<br />WC 021417577 - FL
<br />WC 021417578 -NY
<br />WC 021417582 - CT, OC, HI, 10. IL, IN, LA, MI, NE, NJ
<br />The City of Sauna Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insureds as respects the General Liability policy, where required by written contract. This insurance is
<br />Primary over any similar insurance available to any person or organization we have added to Ws policy as Additional Insureds.
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<br />W ZUUU AGUHU cOHPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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