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AGENCY CUSTOMER ID: CN101348564
<br />_ LOC #: Los Angeles
<br />ACC) ® ADDITIONAL REMARKS SCHEDULE
<br />Page 2 of 2
<br />AGENCY
<br />NAMED INSURED
<br />Marsh Risk & Insurance Services
<br />AECOM
<br />AECOM Technical Services, Inc.
<br />401 West A Street, Suite 1200
<br />POLICY NUMBER
<br />San Diego, CA 92101
<br />CARRIER
<br />NAIL 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 />Workers Compensation/Employer Liability cont
<br />Policy Number Insurer
<br />WC 014629625 American Home Assurance Company - NAI C #19380
<br />WC 014629626 The Insurance Company of the State of Pen nsylvania-NAIC#19429
<br />WC 014629527 The Insurance Company of the State of Pennsylvania - NAIC #19429
<br />WC 014629528 The Insurance Company of the State of Pennsylvania-NAIC#19429
<br />WC 014629529 The Insurance Company of the State of Pennsylvania - NAIC #19429
<br />XWC 0910717 Nat'l Union Fire Ins Go-NAIC#19445
<br />qualified
<br />States Covered
<br />CA
<br />AN, AL, AR, AZ, CO, CT, DC, DE, GA, HI, IA, ID, IL, IN, KS
<br />KY, LA, MD, MI, MN, MO, MS, MT, NO, NE, NH, NJ, NM, NV,
<br />NY, OK, OR, PA, RI, SC, SO, TN, TX, UT, VA, VT, WV
<br />MA, WI (ND, OH, WA, WI, WY - Covered for Stop -Gap EL only)
<br />FL
<br />ME
<br />OH, Ohio Qualified Self Insured (QSI) - SIR: $500,000: Only applicable to specific
<br />entitles self -insured in the state of Ohio
<br />101 (2008/01)
<br />© 2008 ACORD
<br />fhe ACORD name and logo are registered marks of ACORD
<br />reserved.
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