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k. 2 -DI tv ' oIR('-'*) <br />A`oR" CERTIFICATE OF LIABILITY INSURANCE <br />DA 1z/1/zo1 <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(les) 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 />CONTACT <br />NAME: JILT Specialty IDSA <br />PHONE 415-930-9060 a No: <br />135 Main Street <br />Suite 1600 <br />San Francisco, CA 94105 <br />E-MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE NAIC IN <br />7/1/2016 <br />INSURER A: AXA Insurance Company 33022 <br />www.jltre.com California License: OH01556 <br />INSURED <br />Kapsch Traf cCorn Holding II US Corp. <br />8 20 1 Greensboro Drive <br />INSURER B: Great Northern Insurance Company 20303 <br />INSURER C: Chubb Indemnity Insurance Company 12777 <br />INSURER D: <br />Suite 1002 <br />McLean VA 22102 <br />NSURER E: <br />NSURERF: <br />AUT <br />✓ <br />✓ <br />COVERAGES CERTIFICATE NUMBER: gQnA7Ana 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 />INBR <br />TR <br />TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MWDD EXP <br />LIMITS <br />A <br />COMMERCIAL GENERAL LI ABILITY <br />CLAIMS -MADE F✓ OCCUR <br />PCS003157(17) <br />11/30/2017 <br />7/1/2016 <br />EACHOCCURRENCE $1000000 <br />DAMAGE TO <br />PREMISES EaENTED =Rmnce $1,000,000 <br />MED EXP (Any one person) $10,000 <br />PERSONAL&ADV INJURY $1,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />POLICY �✓ SECOT DLOC <br />✓ OTHER: EBL Deductible: 1 000 <br />GENERALAGGREGATE $2,000,000 <br />PRODUCTS-COMP/OP AGG $2000000 <br />Em Io ee Benefits E&O $1,000,000 <br />B <br />AUT <br />✓ <br />✓ <br />OMOBILELIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED F-1 <br />AUTOS ONLY AUTOS ONLD <br />(17)73565101 <br />11/30/2017 <br />7/1/2018 <br />COMBINED ISINGLE LIMIT $1000000 <br />BODILY INJURY (Per person) $1 Dog goo <br />BODILY INJURY (Per accident) $ 1 000 o0o <br />P OPER DAMAGE $1,000,000 <br />A <br />UMBRELLA LIAR <br />EXCESS LIAB <br />N <br />OCCUR <br />CLAIMS -MADE <br />XS003158(17) <br />11/30/2017 <br />7/1/2018 <br />EACHOCCURRENCE $5000000 <br />AGGREGATE $5000000 <br />DED ✓ RETENTION $10,000 <br />L $ <br />G <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOMPARTNEWEXECUTIVE <br />OFFICEMMEMBEREXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />I <br />(17)71751328 <br />11/30/2617 <br />7/1/2018�/ <br />STATUTE EERH <br />YIN <br />V <br />E.L. EACH ACCIDENT $1000000 <br />E.L. DISEASE -EA EMPLOYEE $1 QQQ,QQQ <br />E.L. DISEASE -POLICY LIMIT $1000000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it mora apace is required) <br />City of Santa Ana, PWA - 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 - Tmnsporta0on & Traffic Engineering <br />Department on the General Liability, Auto Liability, Umbrella Liability, and Workers Compensation where required by written contract. <br />{AAJA- �mt°9M " W1 i5_1114 <br />CI of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Attn: Vinh Nguyen, P.E., Sr. Civil Engineer ACCORDANCE WITH THE POLICY PROVISIONS. <br />PWA - Transportation & Traffic Engineering <br />20 Civic Center Plaza <br />Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE <br />I Matt Rush <br />© 015 ACORD CORPORATION. All <br />Gjrights <br />^'reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marksrks of of ACORD <br />39047404 117-18 - CL AU UPS WC I Matt Rush 112/1/2017 11;16;22 AM (CST) I Page 1 of 2 <br />S/ 87Pfje/a.{- <br />iJ <br />J <br />