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2022/01/17 Anser Advisory, LLC (3)
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD PRODUCER CONTACTNAME:FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND 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 RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS 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 E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below 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 INACCORDANCE 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 10/24/2022 (703) 827-2277 (703) 827-2279 20478 Anser Advisory, LLC 2677 North Main Street Suite 400 Santa Ana, CA 92705 35289 20427 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 1,000,000A 7011411369 10/26/2021 1/17/2023 10,000,000B 7011652381 10/26/2021 1/17/2023 10,000,000 10,000 C 7011411372 1/17/2022 1/17/2023 1,000,000N1,000,000 1,000,000 D Professional Liab. MKLV7PL0005111 1/17/2022 Per Claim/Aggregate 2,000,000 CIP 22-06 Menifee Road Resurfacing Project Labor Compliance Services City of Menifee, its officers, agents and employees are additonal insured for general liability & auto liability when required by written contract. 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3DJH RI (IIHFWLYH 'DWH ,QVXUHG 1DPH &RS\ULJKW &1$$OO 5LJKWV 5HVHUYHG ,QFOXGHV FRS\ULJKWHG PDWHULDO RI ,QVXUDQFH 6HUYLFHV 2IILFH ,QF ZLWK LWV SHUPLVVLRQ DocuSign Envelope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ocuSign Envelope ID: 2C4A6552-1FCC-4597-8FF2-EFF4270CBE30 SCA 23 500D (Ed. 10/11) HIJKLMN THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTENDED COVERAGE ENDORSEMENT – BA PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILTY COVERAGE A. Who Is An Insured The following is added to Section II, Paragraph A.1., Who Is An Insured: 1. a.Any incorporated entity of which the Named Insured owns a majority of the voting stock on the date of inception of this Coverage Form; provided that, b.The insurance afforded by this provision A.1.does not apply to any such entity that is an "insured" under any other liability "policy" providing "auto" coverage. 2.Any organization you newly acquire or form, other than a limited liability company, partnership or joint venture, and over which youmaintain majority ownership interest. The insurance afforded by this provision A.2.: a.Is effective on the acquisition or formationdate, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier. b.Does not apply to: (1)"Bodily injury" or "property damage" caused by an "accident" that occurred before you acquired or formed the organization; or (2)Any such organization that is an "insured" under any other liability "policy" providing "auto" coverage. 3.Any person or organization that you are obligated to provide Insurance where required by a written contract or agreement is an insured, but only with respect to legal responsibility for acts or omissions of a person for whom Liability Coverage is afforded under this policy. 4.An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. "Policy," as used in this provision A. Who Is An Insured,includes those policies that were in force on the inception date of this Coverage Form but: 1.Which are no longer in force; or 2.Whose limits have been exhausted. B. Bail Bonds and Loss of Earnings Section II, Paragraphs A.2.a.(2) and A.2.a.(4) are revised as follows: 1.In a.(2),the limit for the cost of bail bonds is increased from $2,000 to $5,000, and 2.In a.(4),the limit for the loss of earnings is increased from $250 to $500 a day. C. Fellow Employee Section II, Paragraph B.5 does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. II. PHYSICAL DAMAGE COVERAGE A. Towing Section III. Paragraph A.2.,is revised to include Light Trucks up to 10,000 pounds G.V.W. B. Glass Breakage – Hitting A Bird Or Animal – Falling Objects Or Missiles The following is added to Section III, Paragraph A.3.: With respect to any covered "auto," any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. C. Transportation Expenses Section III, Paragraph A.4.a.is revised, with respect to transportation expense incurred by you, to provide: a.$60 per day, in lieu of $20; subject to b.$1,800 maximum, in lieu of $600. D. Loss of Use Expenses Section III, Paragraph A.4.b.is revised, with respect to loss of use expenses incurred by you, to provide: a.$1,000 maximum, in lieu of $600. E. Personal Property The following is added to Section III, Paragraph A.4. SCA 23 500D Copyright, CNA Corporation, 2000.Page 1 of 3 (Ed. 10/11)Includes copyrighted material of the Insurance Services Office used with its permission. 3ROLF\ 1XPEHU DocuSign Envelope ID: 2C4A6552-1FCC-4597-8FF2-EFF4270CBE30 SCA 23 500D (Ed. 10/11) HIJKLMN c.We will pay up to $500 for loss to Personal Property which is: (1)Owned by an "insured"; and (2)In or on the covered "auto." This coverage applies only in the event of a total theft of your covered "auto." This insurance is excess over any other collectible insurance and no deductible applies. F. Rental Reimbursement The following is added to Section III, Paragraph A.4.: G We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss"to a covered "auto." Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto." No deductibles apply to this coverage. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: D The number of days reasonably required to repair or replace the covered "auto"; or, E 15 days. Our payment is limited to the lesser of the following amounts: D Necessary and actual expenses incurred; or,$25 per day subject to a maximum of$375. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. If "loss" results from the total theft of a covered "auto" of the private passenger type,we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. G.Hired "Autos" The following is added to Section III. Paragraph A.: 5.Hired "Autos" If Physical Damage coverage is provided under this policy, and such coverage does not extend to Hired Autos, then Physical Damage coverage is extended to: a.Any covered "auto" you lease, hire, rent or borrow without a driver; and b.Any covered "auto" hired or rented by your "employee" without a driver, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c.The most we will pay for any one "accident" or "loss" is the actual cash value, cost of repair, cost of replacement or $75,000 whichever is less minus a $500 deductible for each covered auto. No deductible applies to "loss" caused by fire or lightning. d.The physical damage coverage as is provided by this provision will be limited to the types of physical damage coverage(s) provided on your owned "autos." e.Such physical damage coverage for hired "autos" will: (1)Include loss of use, provided it is the consequence of an "accident" for which the Named Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing or rental concern. (2)Such coverage as is provided by this provision G.e.(1)will be subject to a limit of $750 per "accident." H. Airbag Coverage The following is added to Section III, Paragraph B.3. The accidental discharge of an airbag shall not be considered mechanical breakdown. I. Electronic Equipment Section III, Paragraphs B.4.c and B.4.d.are deleted and replaced by the following: c.Physical Damage Coverage on a covered "auto" also applies to "loss" to any permanently installed electronic equipment including its antennas and other accessories d.A $100 per occurrence deductible applies to the coverage provided by this provision. J. Diminution In Value The following is added to Section III, Paragraph B.6. SCA 23 500D Copyright, CNA Corporation, 2000.Page 2 of 3 (Ed. 10/11)Includes copyrighted material of the Insurance Services Office used with its permission. 3ROLF\ 1XPEHU DocuSign Envelope ID: 2C4A6552-1FCC-4597-8FF2-EFF4270CBE30 SCA 23 500D (Ed. 10/11) HIJKLMN Subject to the following, the "diminution in value" exclusion does not apply to: a.Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b.Any covered "auto" of the private passenger type hired or rented by your "employee" without a driver for a period of 30 days or less, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c.Such coverage as is provided by this provision is limited to a "diminution in value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or incomplete maintenance or repairs; or the installation of substandard parts. d.The most we will pay for "loss" to a covered "auto" in any one accident is the lesser of: (1)$5,000; or (2)20% of the "auto's" actual cash value (ACV) III. Drive Other Car Coverage – Executive Officers The following is added to Sections II and III: 1.Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while in the care, custody or control of, any of your "executive officers," except: a.An "auto" owned by that "executive officer" or a member of that person's household; or b.An "auto" used by that "executive officer" while working in a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision will be: (1)Equal to the greatest of those coverages afforded any covered "auto";and (2)Excess over any other collectible insurance. 2.For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. IV.BUSINESS AUTO CONDITIONS $ Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph $ 2.a. Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual,to any of your executive officers or partners or your nsurance manager. The following is added to Section IV, Paragraph A.2.b. (6)Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph B.2. Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. C. Policy Period, Coverage Territory Section IV, Paragraph B.7.b.(5)is revised to provide: a.45 days of coverage in lieu of 30 days V. DEFINITIONS Section V. Paragraph C.is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these SCA 23 500D Copyright, CNA Corporation, 2000.Page 3 of 3 (Ed. 10/11)Includes copyrighted material of the Insurance Services Office used with its permission. 3ROLF\ 1XPEHU DocuSign Envelope ID: 2C4A6552-1FCC-4597-8FF2-EFF4270CBE30