Wallace for City of Redondo COI — Redondo Beach City Council, June 7, 2022

ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD
PRODUCER CONTACT NAME: PHONE FAX
(A/C, No, Ext): (A/C, No): E-MAIL ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS - COMP/OP AGG OTHER: $ COMBINED SINGLE LIMIT
(Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $
$ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
11/18/2021
(703) 827-2277 (703) 827-2279
20478
Wallace & Associates Consulting, Inc.
1203 Angus Court
Park City, UT 84098
35289
20508
35378
A 1,000,000
7011411355 10/26/2021 1/17/2023 1,000,000
15,000
1,000,000
2,000,000
2,000,000
A 1,000,000
7011411369 10/26/2021 1/17/2023
B 10,000,000
7011652381 10/26/2021 1/17/2023 10,000,000
10,000
C
7011411386 10/26/2021 1/17/2022 1,000,000 N 1,000,000
1,000,000
D Professional Liab. MKLV7PL0004397 10/26/2020 Per Claim/Aggregate 2,000,000 RE Alta Vista Sewer Pump Station Project, Job No. 50300 City of Redondo Beach, its officers, elected and apointed officials, employees, and volunteers are included as additional insureds with respects to General Liability and Umbrella Liability when required by written contract. General Liability and Automobile Liability are primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and when required by written contract. General Liability, Automobile Liability and Workers Compensation policies include a waiver of subrogation in favor of the additional insureds where permissible by state law and when required by written contract. 30-day Notice of Cancellation will be issued for the General Liability, Automobile Liability, Umbrella Liability, Workers Compensation and Professional Liability policies in accordance with policy terms and conditions.

City of Redondo Beach
Engineering Division
415 Diamond Street
Redondo Beach, CA 90277
ANSERAD-01 TWANYOIKE
Ames & Gough
8300 Greensboro Drive
Suite 980
McLean, VA 22102
[email protected]
National Fire Insurance Company of Hartford A(XV)
Continental Insurance Company A(XV)
Valley Forge Insurance Company A(XV)
Evanston Insurance Company
X
1/17/2022
X
X
X X
X
X
X
X

CNA PARAMOUNT
Changes - Notice of Cancellation or Material
Restriction Endorsement
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

EMPLOYEE BENEFITS LIABILITY COVERAGE PART

LIQUOR LIABILITY COVERAGE PART

OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

RAILROAD PROTECTIVE LIABILITY COVERAGE PART

STOP GAP LIABILITY COVERAGE PART

TECHNOLOGY ERRORS AND OMISSIONS LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY – NEW YORK DEPARTMENT OF TRANSPORTATION

SCHEDULE
Number of days notice (other than for nonpayment of premium): 030 Number of days notice for nonpayment of premium: 10
Name of person or organization to whom notice will be sent: PER SCHEDULE ON FILE Address: PER SCHEDULE ON FILE

PER SCHEDULE ON FILE
,
XX 00000
If no entry appears above, the number of days notice for nonpayment of premium will be 10 days.

It is understood and agreed that in the event of cancellation or any material restrictions in coverage during the policy period, the Insurer also agrees to mail prior written notice of cancellation or material restriction to the person or organization listed in the above Schedule. Such notice will be sent prior to such cancellation in the manner prescribed in the above Schedule.

All other terms and conditions of the Policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy.

Policy No: 7011411355
Endorsement No: 17
Effective Date: 10/26/2021
CNA74702XX (1-15)

Page 1 of 1 ends

Nat'l Fire Ins Co of Hartford
Insured Name: ANSER ADVISORY, LLC
Copyright CNA All Rights Reserved.
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II ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY
Business Auto Policy
Policy Endorsement
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:

SCHEDULE
Name of Additional Insured Person Or Organization
Any person or organization that you are required by written contract to make an additional insured under this insurance is an "insured", but only with respect to that person or organization's legal liability for acts or omissions of a person who qualifies as an "insured" for Liability Coverage under Section II Who Is An Insured of this Coverage Form

1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy.

2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy.

All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy.

Form No: CNA71527XX (10-2012)
Endorsement Effective Date: Endorsement Expiration Date:

Policy No: BUA 7011411369
Policy Effective Date:
10/26/2021 Policy Page: 56 of
129

POLICY HOLDER NOTICE - COUNTRYWIDE
It is understood and agreed that:

If the Named Insured has agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if the Insurer cancels a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective.

If notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice.

Any failure by the Insurer to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon the Insurer or the Agent of Record. © Copyright CNA All Rights Reserved.

Form No:

Underwriting Company:

Policyholder Notice Page: 1 of 1
National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 CNA75532XX (01-2015) Policy No: BUA 7011411369
Policy Effective Date: 10/26/2021
Business Auto Policy
Policy Endorsement
CNA Paramount Excess and Umbrella Liability
Policyholder Notice

POLICY HOLDER NOTICE - COUNTRYWIDE
It is understood and agreed that:

If notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice.

Form No:

Underwriting Company:

Policyholder Notice Page: 1 of 1
The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 CNA75532XX (01-2015) Policy No: CUE 7011652381
Policy Effective Date: 10/26/2021
Policy Page: 53 of 53

POLICY HOLDER NOTICE - COUNTRYWIDE
It is understood and agreed that:

If notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice.

Form No:

Underwriting Company:

Policyholder Notice Page: 1 of 1
Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606 CNA75532XX (01-2015) Policy No: WC 7 11411386
Policy Effective Date: 10/26/2021
Workers Compensation And Employers Liability Insurance
Policy Endorsement

Redondo Beach City CouncilJune 7, 2022

Redondo Beach City Council
June 7, 2022