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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 <br />MAMMOSUAED <br />URS Corporation <br />600 MW4001" Sveec, 261h Floor <br />San FrenCei CA 94111 <br />POLICY NDMBEN <br />cmmm <br />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 WCrkers CWP�uan Coverage S W does nO apply in ffaWC6i stoles. N dE Stales of ND. OH, WA and WY Workers' Compelsalion coveage is prwided bythe State Fund. kl0nse Stoles, the above <br />relBenced p0m probe SlopGap Employces Udwky only. Workers CmPenswon pdkies appy as romea Delwv: <br />Dsurel A: Naaorel Union Fire Ins Co PiKsburgh, PA NAICI 19445100 <br />WC 021417576 -CA <br />WC 021417579 -TX <br />Mum Insurance CwWy Of The Slae OI PA 14AICA 19429100 <br />WC 021417580 . K A, WI (Stop Gap) <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 />WCO21411585 -MN <br />Insurer C: MMIOS Na1Dnw kls Co NAICT 27817001 <br />WC 021417577 -FL <br />WC 021417576 -NY <br />WC 021417582 - CT, OC, HI, to IL, IN, Vl MI, NE. NJ <br />The CKy G Santa AIM. AS Officers. employees, agens, volulleers arM represerummes are D[Ided as Addoons kWedsm respeas the Geneal LaNRy poky. Bhee requited by Wilten conont. TNsnmrarrcb <br />Pfn"aveairys finsu eavail *emartypelsanaorgaa=Dnv2haveadded Wdkspokyas AdMa,Mlmmds. <br />ACORD 101 (20011 1) 02008 ACORD CORPORATION. All rights ressived. <br />...o ...........,�,,,o -I-- i1W ew- 119110111013 m r" Or ACORD <br />25H -42 <br />