Holder Identifier : 7777777707070700077761616045571110777707006315547207453126763506200072651466047221130772415557037455607163045662275553075772760261337650705023744607777307040047132365120076727242035772000777777707000707007 77777777 7 7 7 73525677115456000723100417 371120070223373420721 7022236252063111 7122237353 73 11 7132236253173 1 7 33227343173 7122226352163111 7023337352173 1 777561633517655407777777 7 7 7 7 Certificate No : 570121781824
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
07/08/2026
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).
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.
PRODUCER
Aon Risk Services Central, Inc.
Chicago IL Office
200 East Randolph
Chicago IL 60601 USA
PHONE
(A/C. No. Ext):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
(312) 381-1000
INSURED INSURER A: Great Northern Insurance Co. 20303
INSURER B: Chubb Indemnity Insurance Co. 12777
INSURER C: Chubb National Ins Co 10052
INSURER D: Federal Insurance Company 20281
INSURER E:
INSURER F:
FAX
(A/C. No.): (312) 381-7007
CONTACT
NAME:
Forvis Mazars, LLP
Attn: Scott Henderson
910 East St. Louis Street
Suite 400
Springfield MO 65806 USA
COVERAGES CERTIFICATE NUMBER: 570121781824 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. Limits shown are as requested
POLICY EXP
(MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR
WVD INSR LTR ADDL TYPE OF INSURANCE INSD POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
POLICY LOC
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
X
X
X
X
GEN'L AGGREGATE LIMIT APPLIES PER:
$1,000,000
$1,000,000
$25,000
$1,000,000
$2,000,000
Included
Blanket Additional Insured
A 09/30/2025 09/30/2026
General Liability
30040658
PROJECT
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED AUTOS
ONLY
NON-OWNED
AUTOS ONLY
BODILY INJURY ( Per person)
PROPERTY DAMAGE X X (Per accident)
BODILY INJURY (Per accident)
$1,000,000 A 09/30/2025 09/30/2026
Auto
COMBINED SINGLE LIMIT
(Ea accident)
7362-88-88
EXCESS LIAB
X OCCUR
CLAIMS-MADE AGGREGATE
EACH OCCURRENCE
DED
$5,000,000
$5,000,000
09/30/2025
Umbrella UMBRELLA LIAB D 78197191 09/30/2026
RETENTION
X
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
E.L. EACH ACCIDENT $1,000,000
X OTHER
C 09/30/2025 09/30/2026 PER STATUTE
B 2670441241 09/30/2025 09/30/2026
Workers Compensation
$1,000,000
Y / N
(Mandatory in NH)
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? Y N / A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
If yes, describe under
DESCRIPTION OF OPERATIONS below
$1,000,000
2670441240
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City, its officers, elected and appointed officials, employees, and volunteers are listed as additional insureds with respect to General Liability and Auto Liability arising out of work performed by or on behalf of Forvis Mazars, LLP as required by written contract. 30-day notice of cancellation to policy named insured, except 10 days for non-payment.
CERTIFICATE HOLDER CANCELLATION
City of Redondo Beach AUTHORIZED REPRESENTATIVE
415 Diamond Street
Redondo Beach, CA 90277 USA
ACORD 25 (2016/03)
©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.