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AC RO V
<br />AGENCY CUSTOMER ID: URSCOR
<br />LOC 11: San Francisco
<br />ADDITIONAL REMARKS SCHEDULE
<br />Page 2 of 2
<br />AGENCY
<br />MARSH RISK A INSURANCE SERVICES MAMMOSUAED
<br />URS Corporation
<br />600 MW4001" Sven
<br />261h Floor
<br />POLICY NDMBEN ,
<br />San Fren[ima, CA 94111
<br />cmmm NAIC CODE
<br /> EFFECTIVE DALE:
<br />w?,+1 r I?nw? ncwrwn7w
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
<br />The Waters Carpenlie" Coverage shorn does not apply in mmoloc igic stoles. N dE Stales of ND. OH, WA and WY Wakens' C=pelsalion coveage is prwided bythe State F" h Once Stoles, 0e above
<br />referenced p0m prwoe SlopGap Empbyces Udwky only. Wakm ConWiRuan policies appy as kooaed helm:
<br />reorel A: Naaorel Union Fire Im Co Pusburgh, PA NAICI 19445100
<br />WC 021417576 -CA
<br />WC 021417579 -TX
<br />Mum O: Insurance CwWy Of The Slae OI PA 14AICA 19429100
<br />WC 021417580 . K A, WI (Stop Gep)
<br />WC 021417581 - AK AL, AR, AZ, CO, DE, CA, ID, KS, KY. M0, ME, MO, MS, MT, NC, NH, NM, NV, OK. OR, PA RI, SC, SO, TN, UT, VA, VT, WV
<br />WC021411585 -MN
<br />usurer C: MMus Nemirow kl5 Co NAICT 27817001
<br />WC 021417577 -FL
<br />WC 021417576 -NY
<br />WC 021417582 - CT, OC, HI, V, IL, IN, LA, MI, NE. NJ
<br />The Cey of Saaa AIM. as arras, unpioyee%agens, vauleers aro represenMlNes are ir¢Wee as Addoms Maedsm respeas the General LaNRy poky. Bhee requited by Wilten conont. TNsnmr 5
<br />PanayovawWskrMarinsu eavailableWartypersonaOrgad=iDn WehaveaddedOMpokyas AdMa,Mlmmds.
<br />ACORD 101 (20011 1) 02008 ACORD CORPORATION. All rights ressived.
<br />...o ...........,?,,,o and nsyn ew-119110111013 m r" Or ACORD
<br />25H-42
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