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ACOKO® <br />AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page —of <br />AGENCY <br />NAMED INSURED <br />JILT Specialty USA <br />Kapsch TrafficCom Holding II US Corp. <br />8201 Greensboro Drive <br />$ulte 1002 <br />McLean VA 22102 <br />POLICY NUMBER <br />PCS003157 17 <br />CARRIER <br />NAIC CODE <br />AXA Insurance Company <br />33022 <br />EFFECTIVE DATE: 11/30/2017 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) <br />HOLDER: City of Santa Ana Attn: Vinh Nguyen, P.E., Sr. Civil Engineer PWA - Transportation & Traffic Engineering <br />ADDRESS: 20 Civic Center Plaza Santa Ana CA 92701 <br />Policies evidenced herein include the following as Named Insureds <br />Kapsch TrafficCom Holding Corp. <br />Kapsch TrafficCom Inc. <br />Kapsch TrafficCom USA, Inc. <br />Streetline Inc. <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD ATTACHMENT <br />39049404 1 17-18 - GL AS UPS WC I Matt Rush 1 12/1/2017 11:16:22 AM (CST) I Page 2 of 2 <br />