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Ai. C>Rblla CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDM'YY) <br />`^""� <br />7/23/2018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). <br />PRODUCER JLT Specialty USA <br />y <br />CONTA T <br />NAME: JILT Special USA <br />135 sin Street <br />Suite 1600 <br />San Francisco, CA 94105 <br />PHONE FAX <br />MIC No ExfP 415.930.9060 I IC No): <br />_ <br />ADDRESS: <br />_ <br />INSURER(5)AFFORDING COVER AGE NAIOq <br />www.'Itus.com California License: OH01556 <br />1 <br />INSURERA: AXA Insurance Company I 33022 <br />INSURED <br />Kappsch TrafficCom Holding II US Corp. <br />8201 Greensboro Drive <br />- <br />INSURER B: Travelers Property Casualty Co of Amer 25674 <br />- - - <br />INSURERC: <br />INSURERD: <br />Suite 1002 <br />McLean VA 22102 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 43250357 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSIR <br />TYPE OF INSURANCE <br />ADDL <br />D <br />SUBR- <br />D <br />POLICY NUMBER <br />POLICYEFF <br />fMMIDDNWV <br />POLICY E%P - <br />MMIDOMIYY LIMITS <br />A <br />�/'COMMERCIALGENERAL LIABILITY <br />t <br />CLAIMS-MADE✓!OCCUR <br />_ <br />GE NIL AGGR EG_AT_E U M IT APPLI ES PER <br />�--, POLICY ✓ JECT C LOC <br />✓ ''.. OTHER. EBL Deductible: $1 000 <br />PCS003157(18) <br />''', <br />7111201$ <br />71112119 <br />EACH OCCURRENCE <br />�MAG REET� n E <br />III PREMISES (EA occurrence) <br />$1,000000 <br />"- <br />$1,000000- <br />MED EXP (Anyone person) <br />$10,000 <br />PERSONAL & ADV INJURY <br />$1 000 000 <br />GENERALAGGREGATE <br />32,000,000 <br />PRODUCTS - COMP/OP AGG <br />$2000 OOO <br />Em to ee Benefits E&O <br />$1 000 000 <br />B <br />AUTOMOSILELIABILITY <br />ANYAUTO <br />'OWNED SCHEDULED <br />AUTOSONLY AUTOS <br />r HIRED NON -OWNED <br />L_AUTOSONLY AUTOS ONLY <br />-810-OL339608-18 <br />7/1/2018 <br />7/1/2019 <br />COMod DSINGLE LIMIT <br />li $1000,000 <br />BODILY I NJU RY(Per person)'I$ <br />--- <br />BODILY INJURY (Per accident).$ <br />PROPERTY DAMAGE <br />Per accitlern) <br />-— <br />$.. <br />A ✓'. UMBRELLA LIAB <br />EXCESS LIAB <br />✓ <br />OCCUR <br />CLAIMS -MADE <br />XS00315$(1$) <br />i,. 7/1/2018 <br />7/1/2019 <br />EACHOCCURRENCE <br />$5,000,000 <br />AGGREGATE <br />$5,000,000 <br />DED ✓ RETENTION$ 10,000 <br />B WORKERS COMPENSATION <br />'ANDEMPLOYERS' LIABILITY YIN <br />ANYPROPRIETOR/PARTNERIEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑N <br />I(MandatoryInNH) <br />If yes, describe under <br />'. DESCRIPTION OF OPERATIONS below <br />NIA', <br />I <br />UB-OL500865-18 <br />7I1I201$ <br />7/1/2019 PER I OTH- <br />V -STATUTE I ER <br />E. L. EACH ACCIDENT <br />— -- <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. DISEASE -POLICY LIMIT <br />$1,000,000 <br />- -- <br />$1000000_ <br />$ 1 00O 000 <br />DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />Contract Numbers: A-2016-057 and A-2016-080 <br />City of Santa Ana, Fri - Transportation & Traffic Engineering Department are are included as additional insured (except for Workers Compensation) <br />where required by written contract. Waiver of Subrogation is applicable in favor of City of Santa Ana, PWA- Transportation & Traffic Engineering <br />Department on the General Liability, Auto Liability, Umbrella Liability, and Workers Compensation where required by written contract. <br />City of Santa Ana <br />Attn: Vinh Nguyen, P.E., Sr. Civil Engineer <br />PWA - Transportation & Traffic Engineering <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />nn�H o„�F <br />ACORD 25 (2016103) <br />©1988-2015 ACORD CORPORATION. All <br />The ACORD name and logo are registered marks of ACORD <br />93250359 110-19 - GL AV PTIE WC I Amy Clarke 17/23/2018 7:39:53 BP (CDT) I Page 1 of 2 <br />