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A/""" h�
<br />/lw CERTIFICATE OF LIABILITY INSURANCE
<br />DATE ( YYYY)
<br />11I30/2016
<br />12016
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />MARSH USA, INC.[
<br />99 HIGH STREET-
<br />CONTACT
<br />NAME:
<br />_
<br />PHONE FAX
<br />(A/C, No Ext): (A/C, No):
<br />BOSTON, MA 02110';1
<br />Attn: Boston.certrequest@Marsh.com Fax: 212-948.4377
<br />EMAIL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: Federal Insurance Company 20281
<br />116924947-all-GAWU-16-17
<br />INSURED
<br />Kapsch TrafficCom Transportation NA, Inc:
<br />8201 Greensboro Drive:'
<br />INSURER B : Great Northern Insurance Company '.20303
<br />_
<br />Chubb Indemnity Insurance Company 12777
<br />INSURER c : Y P y
<br />INSURER D :
<br />Suite 10021'
<br />Mclean, VA 22102
<br />— -- ---
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: NYC-008687448-01 REVISION NUMBER:O
<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 RrEDUCED BY PAID CLAIMS.
<br />IXP
<br />�TR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />EFF
<br />I MM/DD/YWY
<br />MM/DDIPOLICY
<br />YEYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />9949-16-74
<br />11/30/2016
<br />11/30/2017
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE T OCCUR
<br />DAMAGES( RENTED
<br />PREMISES Ea occurrence)
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />_
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />X POLICY El PRO-
<br />JECT ❑ LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />I
<br />B
<br />AUTOMOBILE LIABILITY
<br />7356-51-01
<br />11/30/2016
<br />11/30/2017
<br />(CEO MBINED SINGLE LIMIT accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ''. ANY AUTO
<br />'.. ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />X UMBRELLA LIAB
<br />�'..
<br />X
<br />OCCUR
<br />7983-64-37
<br />11/30/2016
<br />11/30/2017
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED' 7N
<br />N / A
<br />(17)7175-13.28
<br />11/30/2016
<br />11/30/2017
<br />X STATUTE �RH
<br />"-"
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<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 />---
<br />E.L. DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />RE-IWYWEf1 E1Y__._
<br />F tl4 f-EMA(FG Ckl` p
<br />_
<br />NW^EUNIC
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, PWA - Transportation & Traffic Engineering Department are are included as additional insured (except for Workers Compensation) where required by written contract. Waiver of Subrogation is
<br />applicable in favor of City of Santa Ana, PWA - Transportation & Traffic Engineering Department on the General Liability, Auto Liability, Umbrella Liability, and Workers Compensation where required by written
<br />contract.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana:!
<br />Attn: Vinh Nguyen, RE., Sr. Civil Engineer.
<br />PWA - Transportation & Traffic Engineering,:
<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 />20 Civic Center Plazas.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Elizabeth Stapleton
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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