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AGENCY CUSTOMER ID: <br />_ LOC #: <br />ACC ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY NAMED INSURED <br />JLT S ecialt USA Kappsch TrafficCom Holding II US Corp. <br />P Y 8201 Greensboro Drive <br />POLICY NUMBER Suite 1002 <br />McLean VA 22102 <br />CARRIER i NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <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 />43250357 1 18-19 - G:, AU UMB WC I Amy Clarke 1 7/23/2018 7:39:53 AM (CDT) I Page 2 of 2 REVIEWED BY: EUNICE HEREDIA (PG OF ) <br />