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ACORD®CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYY)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 />CONTACT <br />NAME: JILT Specialty USA <br />135 Main Street <br />Suite 1600 <br />San Francisco, CA 94105 <br />A/C NNo EXt : 415.930.9060 a No): <br />E-MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A: AXA Insurance Company 33022 <br />www.jltus.com California License: OH01556 <br />INSURED <br />Kappsch TrafficCom Holding II US Corp. <br />8201 Greensboro Drive <br />INSURER B : Travelers Property Casualty Cc of Amer 25674 <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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />TYPE OF INSURANCE <br />INS L <br />SWVD <br />POLICY NUMBER <br />MWDCU EFF <br />EXP <br />MMIDDPOLIC/YYYY <br />LIMITS <br />A <br />�/ COMMERCIAL GENERAL LIABILITY <br />PCS003157(18) <br />7/1/2018 <br />7/1/2019 <br />EACH OCCURRENCE <br />I $1,000,000 <br />CLAIMS -MADE . OCCUR <br />DAMAGETO S(RENTED <br />PREMISES Ea occurrence) <br />$ 1,000,000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1 ,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$2,000,000 <br />POLICY Z jECT [] LOC <br />PRODUCTS - COMP/OP AGG <br />$2,000000 <br />Employee Benefits E&O. <br />$1 000 000 <br />✓ OTHER: EBL Deductible: $1,000 <br />B <br />AUTOMOBILE LIABILITY <br />81O-OL339608-18 <br />7/1/2018 <br />7/1/2019 <br />COMBINEDSINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />✓ ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />j <br />PROPERTYDAMAGE <br />Per accident <br />$ <br />Is <br />A <br />/ UMBRELLALIAB <br />✓ OCCUR <br />XS003158(18) <br />7/1/2018 <br />7/1/2019 <br />EACH OCCURRENCE <br />$5,000,000 <br />AGGREGATE <br />$ 5,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />i <br />DIED ✓ RETENTION $10,000 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANYPROPRIETOR/PARTNER/EXECUTNE <br />OFF N <br />N/A <br />UB-OL500865-18 i <br />I <br />7/1/2018 <br />7/1/2019 <br />,/ il PER <br />STATUTE I EORH <br />E.L. EACH ACCIDENT <br />$ 1 ,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1 OOO OOO <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT I <br />$1 OOO OOO <br />� <br />i <br />I <br />I <br />I <br />DESCRIPTION OF OPERATIONS / LOCATIONS I 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, 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 - Transportation & Traffic Engineering <br />Department on the General Liability, Auto Liability, Umbrella Liability, and Workers Compensation where required by written contract. <br />REVIEWED BY: EUNICE HEREDIA (PG I OF ) <br />L.CIK I Iri%,A I C MULUCF( <br />Celt of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Y 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 />Matt Rush <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />43250357 1 18-19 - G:, AD UMB WC I Amy Clarke 1 7/23/2018 7:39:53 AM (CDT) I Page 1 of 2 <br />