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<br />AGENCY CUSTOMER ID: 645175
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<br />ADDITIONAL REMARKS SCHEDULE
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<br />AGENCY NAMED INSURED
<br /> URS Corporation Southern
<br />Willis Insurance Services of California, Inc, 7800 Congress Avenue, Suite 200
<br />POLICY NUMBER Boca Raton, FL 33487
<br />See First Page
<br />CARRIER I NAIC CODE
<br />See First Paqe EFFECTIVE DATE: See First Paoe
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<br />ADDITIONAL REMARKS
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<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
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<br />Workers Compensation policies apply as indicated below:
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<br />WC20635051 - CA
<br />WC20635052 - FL
<br />WC20635053 - TX
<br />WC20635054 - AK, AL, AZ, DC, DE, HI, lA, IL, IN, KS, LA, MD, ME, MI, MO, MS, MT, NC, NE, NH, NJ,
<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
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<br />Jones Act Maritime Coverage provided under the Workers' Compensation policy,
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<br />City of Sunny Isles Beach is included as Additional Insured as respects the General Liability and
<br />Auto Liability policies, where required by written contract,
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<br />ACORD 101 (2008/01)
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<br />Coll: 3417 511 Tpl: 1300507 Cert: 16274225 @200BACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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