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HomeMy WebLinkAboutKAPSCH TRAFFICCOM TRANSPORTAITON NA, INC. (FNA SCHNEIDER ELECTRIC MOBILITY NA, INC.A-2a16-057-03 INSURANCE NOT ON FILE WORK MAY ME PROCEED MAYOR CLERK OF COUNCIL Miguel A. laulldo EM MAYOR PROT'fEM DATE -APR 0 4 2019 Juan Villages COUNCILMEMBERS Cecilia Iglesias David Pennloza t. ON. TVA, l' Roman Rayna Vicente Sanienloe > Jose Solcrio 4(Laytiv PUBLIC WORKS AGENCY 20 Civic Center Plaza M-36 . P.O. Box 5988 M-36 Santa Ana, California 92702 WWW.santa-ana.arc February 15, 2019 Kapsclr TrafficCom USA, Inc. 1390 Piceard Drive, Suite 200 Rockville, MD 20850 Attn: Farhad Pooran Re: Extension of Consultant Agreement No. A-2016-057 ACTING CITY MANAGER Steven A. Mendoza Off ATTORNEY Sonia R, Carvalho ACTING CLERK OF THE COUNCIL Norma Mitre Pursuant to Section 3 ("Term") of Agreement No. A-2016-057, entered into by Kapsch TraffrcCom USA, Inc. and the City of Santa Ana, dated April 6, 2016 and as amended, the time period of the Agreement is hereby extended for an additional one (1) year period, from April 1, 2019.through March 31, 2020. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement, as amended, remain unchanged and in full force and effect. If you have any questions regarding this matter, please contact Cesar Rodriguez in the Public ,Korks Agency at 714-647-5626, ;7 S. Sweiss, PE, PLS ative Director, Public Works Agency OF SANTA ANA Steven A, Mendoza Acting City Manager APPROVED AS TO FORM 1• vv Pw__E' y n M. Punk, Assistant City Attorney ATTEST Norma Mitre Acting Clerk of the Council ONSULTA Kapsc raffrCom SANTA ANA CITY COUNCIL. Miguel A. P.100 Juan r6I.N. Vicente SarndUntn David Penaloza Jese 50l00 Homan Rayna aerdora Igleslas Mayor Mayor Pro Tem, Ward 5 Ward Ward Wa103 Ward Ward6 _ ut S1.6@n,Ur nLu 'vlllrzoasGilsanuanas�nr 191niert0?J4'intt,yyainyg d ,'d..fmcanta-arc oro =olalo,(QTRAMmanB.oro a9 neysanta n 21ortas k*ggjd-anaom Ai. C>Rblla CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDM'YY) `^""� 7/23/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER JLT Specialty USA y CONTA T NAME: JILT Special USA 135 sin Street Suite 1600 San Francisco, CA 94105 PHONE FAX MIC No ExfP 415.930.9060 I IC No): _ ADDRESS: _ INSURER(5)AFFORDING COVER AGE NAIOq www.'Itus.com California License: OH01556 1 INSURERA: AXA Insurance Company I 33022 INSURED Kappsch TrafficCom Holding II US Corp. 8201 Greensboro Drive - INSURER B: Travelers Property Casualty Co of Amer 25674 - - - INSURERC: INSURERD: Suite 1002 McLean VA 22102 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 43250357 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR TYPE OF INSURANCE ADDL D SUBR- D POLICY NUMBER POLICYEFF fMMIDDNWV POLICY E%P - MMIDOMIYY LIMITS A �/'COMMERCIALGENERAL LIABILITY t CLAIMS-MADE✓!OCCUR _ GE NIL AGGR EG_AT_E U M IT APPLI ES PER �--, POLICY ✓ JECT C LOC ✓ ''.. OTHER. EBL Deductible: $1 000 PCS003157(18) ''', 7111201$ 71112119 EACH OCCURRENCE �MAG REET� n E III PREMISES (EA occurrence) $1,000000 "- $1,000000- MED EXP (Anyone person) $10,000 PERSONAL & ADV INJURY $1 000 000 GENERALAGGREGATE 32,000,000 PRODUCTS - COMP/OP AGG $2000 OOO Em to ee Benefits E&O $1 000 000 B AUTOMOSILELIABILITY ANYAUTO 'OWNED SCHEDULED AUTOSONLY AUTOS r HIRED NON -OWNED L_AUTOSONLY AUTOS ONLY -810-OL339608-18 7/1/2018 7/1/2019 COMod DSINGLE LIMIT li $1000,000 BODILY I NJU RY(Per person)'I$ --- BODILY INJURY (Per accident).$ PROPERTY DAMAGE Per accitlern) -— $.. A ✓'. UMBRELLA LIAB EXCESS LIAB ✓ OCCUR CLAIMS -MADE XS00315$(1$) i,. 7/1/2018 7/1/2019 EACHOCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED ✓ RETENTION$ 10,000 B WORKERS COMPENSATION 'ANDEMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N I(MandatoryInNH) If yes, describe under '. DESCRIPTION OF OPERATIONS below NIA', I UB-OL500865-18 7I1I201$ 7/1/2019 PER I OTH- V -STATUTE I ER E. L. EACH ACCIDENT — -- E.L. DISEASE - EA EMPLOYEE E.L. DISEASE -POLICY LIMIT $1,000,000 - -- $1000000_ $ 1 00O 000 DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Contract Numbers: A-2016-057 and A-2016-080 City of Santa Ana, Fri - Transportation & Traffic Engineering Department are are included as additional insured (except for Workers Compensation) where required by written contract. Waiver of Subrogation is 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 contract. City of Santa Ana Attn: Vinh Nguyen, P.E., Sr. Civil Engineer PWA - Transportation & Traffic Engineering 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE nn�H o„�F ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All The ACORD name and logo are registered marks of ACORD 93250359 110-19 - GL AV PTIE WC I Amy Clarke 17/23/2018 7:39:53 BP (CDT) I Page 1 of 2 AGENCY CUSTOMER ID: LOC #: ARO ® ADDITIONAL REMARKS SCHEDULE Page —of AGENCY NAMED INSURED JILT Specialty USA P Y Kappsch TrafficCom Holding II US Corp. 8201 Greensboro Drive Suite 1002 McLean VA 22102 POLICY NUMBER PCS003157 18 CARRIER NAIC CODE AXA Insurance Company 33022 EFFECTIVE DATE: 7/1/2018 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: City of Santa Ana Attn: Vinh Nguyen, P.E., Sr. Civil Engineer PWA - Transportation & Traffic Engineering ADDRESS: 20 Civic Center Plaza Santa Ana CA 92701 Policies evidenced herein include the following as Named Insureds: Kapsch TrafficCom Holding Corp. Kapsch TrafficCom Inc. Kapsch TrafficCom USA, Inc. Streetline, Inc. 2008 ACORD CORPORATION_ All rinhfc The ACORD name and logo are registered marks of ACORD ATTACHMENT 43250357 118-19 - GL All UMH VIC I Amy Clarke 17/23/2018 7:39:53 AM (CDT) I Page 2 of 2 POLICY NUMBER: PCS003157(18) COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s) Location And Description Of Completed Operations Any person or organization to whom you become obligated by a written contract to include as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 37 of 72 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 39 of 72 ACORD®CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)7/23/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER JLT Specialty USA CONTACT NAME: JILT Specialty USA 135 Main Street Suite 1600 San Francisco, CA 94105 A/C NNo EXt : 415.930.9060 a No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: AXA Insurance Company 33022 www.jltus.com California License: OH01556 INSURED Kappsch TrafficCom Holding II US Corp. 8201 Greensboro Drive INSURER B : Travelers Property Casualty Cc of Amer 25674 INSURERC: INSURERD: Suite 1002 McLean VA 22102 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 43250357 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INS L SWVD POLICY NUMBER MWDCU EFF EXP MMIDDPOLIC/YYYY LIMITS A �/ COMMERCIAL GENERAL LIABILITY PCS003157(18) 7/1/2018 7/1/2019 EACH OCCURRENCE I $1,000,000 CLAIMS -MADE . OCCUR DAMAGETO S(RENTED PREMISES Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1 ,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY Z jECT [] LOC PRODUCTS - COMP/OP AGG $2,000000 Employee Benefits E&O. $1 000 000 ✓ OTHER: EBL Deductible: $1,000 B AUTOMOBILE LIABILITY 81O-OL339608-18 7/1/2018 7/1/2019 COMBINEDSINGLE LIMIT Ea accident $ 1,000,000 ✓ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY j PROPERTYDAMAGE Per accident $ Is A / UMBRELLALIAB ✓ OCCUR XS003158(18) 7/1/2018 7/1/2019 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE i DIED ✓ RETENTION $10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTNE OFF N N/A UB-OL500865-18 i I 7/1/2018 7/1/2019 ,/ il PER STATUTE I EORH E.L. EACH ACCIDENT $ 1 ,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 OOO OOO (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT I $1 OOO OOO � i I I I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Contract Numbers: A-2016-057 and A-2016-080 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 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 contract. REVIEWED BY: EUNICE HEREDIA (PG I OF ) L.CIK I Iri%,A I C MULUCF( Celt of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Vinh Nguyen, P.E. Sr. Civil Engineer ACCORDANCE WITH THE POLICY PROVISIONS. PWA - Transportation &'Traffic Engineering 20 Civic Center Plaza Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE Matt Rush ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 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 AGENCY CUSTOMER ID: _ LOC #: ACC ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED JLT S ecialt USA Kappsch TrafficCom Holding II US Corp. P Y 8201 Greensboro Drive POLICY NUMBER Suite 1002 McLean VA 22102 CARRIER i NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: City of Santa Ana Attn: Vinh Nguyen, P.E., Sr. Civil Engineer PWA - Transportation & Traffic Engineering ADDRESS: 20 Civic Center Plaza Santa Ana CA 92701 Policies evidenced herein include the following as Named Insureds: Kapsch TrafficCom Holding Corp. Kapsch TrafficCom Inc. Kapsch TrafficCom USA, Inc. Streetline, Inc. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 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 ) POLICY NUMBER: PCS003157(18) COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization to whom you become obligated by a written contract to include as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 37 of 72 REVIEWED BY: EUNICE HEREDIA (PG OF ) COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 39 of 72 REVIEWED BY. EUNICE HEREDIA (PG of ) a� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh Risk and Insurance Services CONTACT r�nME_ Marsh Risk and Insurance Services 345 California Street PHONE FAX Suite 1300 Wc. No, �xt}: 415-743-8000 _(ac, No);__ EMAIL San Francisco, CA 94104 ADDRESS,. www.marsh.com California License: OH01556 INSURED Kappsch TrafficCom Holding II US Corp. 8201 Greensboro Drive Suite 1002 McLean VA 22102 COVERAGES CFRTIFICATF Nt1MRFR- F9r4R7iQa INSURE Is AFFORDING COVERAGE NAIC Y INSURER A: AXA Insurance Company 33022 INSURER B : Travelers PfODerty Casualtv Co of Amer 25674 INSURER D. Charter Oak_ Fire Insurance Company 25615 INSURER E REVISION Nt1MRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSU ADnI: suB POLICY NUMBER POLICYFF MMIDDmYY LIMITS R A COMMERCIALGENERALLIABILITY PCS003157(19) 7/1/2019 7/1/2020 EACHOCCURRENCE $1,00a000 l CLAIMS -MADE �/ OCCUR _ _ }AMAGF rO RENTEV PI{EMISFS jf=aoccurlArtcu), $ t 00 QQO , MED EXP JNky Mu parson) $ 1 O,000 PERSONAL & ADV INJURY . s 1,000,000 ..! fl'L AGGREGATF LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PEA LOC { I..._l mioDUCTs-CQMPIgPAGG T .s2.000000 $,QQ QQQ gTHER: DedUctlblB B AUTOMOBILE LIABILITY 810-1 N626414 7/1/2019 7/1/2020 COMBINEDflISINGLE LIMIT $1_ Q00 000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS $ J BODILY INJURY (Per accident) PROPERTY DAMAGE HIRED NON -OWNED $ AUTOS ONLY .�, AUTOS ONLY $ A UMBRELLA LIAR �/ OCCUR XS003158(19) 7/1/2019 7/1/2020 EACH OCCURRENCE $5 QQQ Q�Q AGGREGATE EXCESS LIAR CLAIMS -MADE $ 5 000,000 DED ✓ RETENTION$ 10.000 $ WORKERS COMPENSATION UB-OL500865 7/1/2019 7/1/2020 f SPER OT TATUTE ER AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE E,L, EACH ACCIDENT $ 1 00000O OFFICER/MEMBER EXCLUDED? nN N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE §A.,000.000 If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ 1,000,000 C .Tech E&O- Professional Liability G25604635004 7/1/2019 7/1/2020 $2.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Contract Numbers: A-2016-057 and A-2016-080 City of Santa Ana, officers, agents, employees, and volunteers, PWA - Transportation & Traffic Engineering Department are included as additional insured (except for Workers Compensation) where required by written contract. Waiver of Subrogation is 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 contract.. COncellaffors clause is amended to 30 day except for 10 day notice of cancellation for non-payment of premium per policy provisions. This Insurance is primary/noncontributory on the General Liability policy for the additional insured when such liability accrues from an act or omisslon of the named insured on tho policy. L;tK I II-IUA I t HULUtK L.AIYLCLLA I IUIV City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 By RISK MANAGEMENT DIVISION lvSP 509 FRAN-� CINE R. VILLAREAL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Matt Rush © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD S135I199 1 19-18 GL AU Uinb WC $2M Professional I Matt Hush 19/2S/2019 1:S'/:31 PM (CDT) I Page 1 of 2 AGENCY CUSTOMER ID: LOC #: .4�oRo® ADDITIONAL REMARKS SCHEDULE L � Page of AGENCY NAMED INSURED Marsh Risk and Insurance Services Kappsch TrafficCom Holding II US Corp. 8201 Greensboro Drive Suite 1002 POLICY NUMBER McLean VA 22102 G25604635004 CARRIER NAIC CODE ACE American Insurance CompanyCompAny 2i67 EFFECTIVE DATE:7/1/2019 ADDITION THIS ADDITIONAL REMARKS FORM IS A SCHEDULE FORM NUMBER: 25 FORM TITLE: Certificate HOLDER: City of Santa Ana Risk Management Division ADDRESS: 20 Civic Center Plaza Santa Ana CA 92702 Policies evidenced herein inclu( Kapsch TrafficCom Holding Corp. Kapsch TrafficCom Inc. Kapsch TrafficCom USA, Inc. Streetline, Inc. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT S1357199 119-1B GL AU Uinb WC $2M Professional I Matt Rush 1 9/25/2019 1:57:31 PM (CDT) I Page 2 of 2