4WRL
GOVEREV-01 KBUCHER
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
10/11/2022
THIS CERTIFICATE 15 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 15 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
Thompson Flanagan Executive Liability Group
626 W. Jackson Blvd. 5th Floor
Chicago, IL 60661
INSURED
Avenu Holdings, LLC
5860 Trinity Parkway Suite 120
Centreville, VA 20120
CONTACT Colleen Sokolowski
NAME:
PHONE FAX
(A/C, No, Ext): (A/C, No):
ADDRESS: [email protected]
INSURER(S) AFFORDING COVERAGE
INSURER A: Hartford Underwriters Insurance Company
INSURER B : Trumbull Insurance Company
INSURER C : Hartford Casualty Insurance Company
INSURER D : Landmark American Insurance Company
INSURER E : Axis Insurance Company
INSURER F :
NAIC #
27120
29424
33138
37273
COVERAGES CERTIFICATE NUMBER: 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DOLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY DAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP
LTR INSD WVD (MM/DD/YYYY) (MM/DDIYYYY)
A X COMMERCIAL GENERAL LIABILITY
B
C
C
CLAIMS -MADE X OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO-
JECT
OTHER:
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
X UMBRELLA LIAR
EXCESS LIAB
■
■
LOC
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
X
DED X RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
IfT
D Prime Tech EgO/Cybers below
E Crime
OCCUR
CLAIMS -MADE
10,000
Y/N
X X 83 UUN AA6800
1/24/2022 1/24/2023
X X 83 UEN AE7365 1/24/2022 1/24/2023
N/A
83 RHU AA6623
83 WE AE7C2X
LCY794123
P-001-000245516-03
1/24/2022 1/24/2023
1/24/2022 1/24/2023
1/24/2022 1/24/2023
3/15/2022 3/15/2023
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
EACH OCCURRENCE
AGGREGATE
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
Per Claim/Agg
Limit
$
1,000,000
300,000
10,000
1,000,000
2,000,000
2,000,000
1,000,000
10,000,000
10,000,000
1,000,000
1,000,000
1,000,000
2,500,000
2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Placentia and its elected and appointed boards, officers, officials, agents, employees, and volunteers are additional insureds with respect to:
liability arising out of activities performed by or on behalf of the Consultant pursuant to its contract with the City; products and completed operations of the Consultant; premises owned, occupied or used by the Consultant; automobiles owned, leased, hired, or borrowed by the Consultant. Consultant shall provide immediate written notice if (1) any of the required insurance policies is terminated; (2) the limits of any of the required polices are reduced; (3) or the deductible or self-insured retention is increased. In the event of any cancellation or reduction in coverage or limits of any insurance, Consultant shall forthwith obtain and submit proof of substitute insurance. Should Consultant fail to immediately procure other insurance, as specified, to substitute for any canceled policy, the City may procure such insurance at Consultant's sole cost and expense. The Consultant's insurance coverage shall be primary insurance SEE ATTACHED ACORD 101
CERTIFICATE HOLDER CANCELLATION
City of Placentia
401 E. Chapman Ave.
(Placentia, CA 92870
ACORD 25 (2016/03)
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
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACRO
AGENCY
hompson Flanagan Executive Liability Group
POLICY NUMBER
SEE PAGE 1
AGENCY CUSTOMER ID: GOVEREV-01
LOC #: 1
ADDITIONAL REMARKS SCHEDULE
CARRIER
SEE PAGE 1
NAIC CODE
SEE P 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
NAMED INSURED
Avenu Holdings, LLC
5860 Trinity Parkway Suite 120
t,entreville, VA 20120
EFFECTIVE DATE: SEE PAGE 1
KBUCHER
Description of Operations/Locations/Vehicles:
as respects the City of Placentia, its officers, officials, agents, employees, and volunteers. Any other insurance maintained by the City of Placentia shall be excess and not contributing with the insurance provided by this policy.
Additional Named Insureds:
1. Government Revenue Solutions Holdings I, LLC
2. Avenu Holdings, LLC
3. Avenu Insights & Analytics LLC
4. MuniServices, LLC d/b/a Avenu MuniServices, LLC
5. eGov Solutions, LLC
6. Ram Ware, LLC
7. Avenu Insights, LLC
8. Avenu Canada
9. Avenu AcquireCo ULC
10. Avenu Pension Administration Solutions ULC
11. Avenu SLS Holdings, LLC
12. Avenu Local Government Solutions, LLC
13. Avenu SLGS Holdings, LLC
14. Avenu Unclaimed Property Systems, LLC
15. Avenu Enterprise Solutuions, LLC
16. Avenu Government Systems, LLC
17. Avenu Government Record Services, LLC
18. Avenu Title Records, LLC
19. The Windward Group LLC
20. CSLS Holdings, LLC
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD