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<br /> AGENCY CUSTOMER ID: 645175
<br /> LOCH:
<br /> '4�s ADDITIONAL REMARKS SCHEDULE Page-2-of 2
<br /> AGENCY NAMED INSURED
<br /> URS Corporation
<br /> Willis Insurance Services of California, Inc. 600 Montgomery Street, 26th Floor
<br /> POLICY NUMBER San Francisco, CA 94111
<br /> See First Page
<br /> CARRIER MAIC CODE
<br /> See First Page EFFECMEDATE: See First Page
<br /> ADDITIONAL REMARKS
<br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br /> FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
<br /> Workers Compensation policies apply as indicated below:
<br /> WCZ8635S52 - FL
<br /> NC20635053 - TX
<br /> NC20635054 - AK, AL, AZ, DC, DE, HI, IA, IL, IN, KS, LA, MD, ME, MI, NO, MS, MT, NC, NE, NH, NJ,
<br /> NM, OK, PA, RI, SC, SD, TN, VA, VT
<br /> WC20635055 - AR, CO, CT, GA, ID, KY, NA, MN, ND, NV, NY, OH, OR, UT, WA, WI, WV, WY
<br /> The City of Decatur and its officers and employees shall be named as additional insured parties on
<br /> th General Liability policy and included as additional insured parties on the Automobile Liability
<br /> poic es, where required by written contract.
<br /> This insurance is Primary and Non-contributory over any similar insurance available to any person
<br /> or organization we have added to this policy as Additional Insureds.
<br /> ACORD 101(2008101) Coil:3375135 Tp1:1260635 Cert:16024347 ®2008ACORD CORPORATION.All rights reseried.
<br /> The ACORD name and logo aro registered marks of ACORD
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