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Digita
<br />DATE ( D/YYYY)
<br />'`�� R" CERTIFICATE OF LIINI ANCE in 3/22121022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O LY IGHTS UPO , THE ERTIFIC E HOLDER. THIS
<br />CERTIFIAE DOES NOT AFIRMATIVELY OR NEGATVEY AMEN HE POLICES
<br />BE OW.0 TTHIS CCERT FIICATEFOF INSURANCE DOES NIOTLCONSTITUTE A CONTRACT TBETWEEN OTHEr SSAL ;AC! AUT OR ZIED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, t li (ie v I I_ . _f� I e e
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions th ai o Ur(Re an endorsemes:t. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). _ 'I n. C C .'i Ci n71nni
<br />PRODUCER CONTACT
<br />NAME: Matt Rush
<br />Marsh & McLennan Agency LLC PHONE - FAX
<br />309 Webster Street A/C No EXt : 513-256-2198 A/c, No): 212-948-6395
<br />Dayton OH 45402 ADDRESS: matt.rush@marshmma.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: XL Insurance America, Inc.
<br />24554
<br />INSURED KAPSCTRAFF
<br />Kapsch TrafficCom USA, Inc.
<br />8201 Greenboro Dr., Ste 1002
<br />Me Lean VA 22102
<br />INSURERB: Hartford Casualty Insurance Company
<br />29424
<br />INSURER C : Interstate Fire & Casualty Company
<br />22829
<br />INSURER D :
<br />COVERAGES CERTIFICATE NUMBER:949775617 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />I
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />US001099721_131A
<br />7/1/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 500,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY PRO-
<br />JECT1:1 LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Deductible
<br />$ $100,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />33UENFH2934
<br />7/1/2021
<br />7/1/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />US001099741_121A
<br />7/1/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />$9,000,000
<br />AGGREGATE
<br />$ 9,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />Y
<br />33WEAL5RL8
<br />7/1/2021
<br />7/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />NIA
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Tech E&O and Cyber
<br />USF00987121
<br />7/1/2021
<br />7/1/2022
<br />$5,000,000
<br />Per Occurrence
<br />$5,000,000
<br />Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Agreement A-2019-203
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insured (except for Workers Compensation) on
<br />a primary noncontributory basis where required by written contract. Waiver of Subrogation is applicable in favor of City of Santa Ana on General Liability, Auto
<br />Liability, and Workers' Compensation where required by written contract. Policies include 30 Days' Notice of Cancellation with 10 Days' Notice for
<br />Non -Payment of Premium in accordance with the policy provisions.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702 .74,4
<br />µ RiakMuwganentDhb1on
<br />tt REVIEWED & APPROVED BY:
<br />© 1988-2015 ACORD
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD _ �IM Risk Managemenc specialist
<br />
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