Attachment_5-C_Supplement_1_Certificate_of_Insurance.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

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 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 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 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

© 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

3/24/2021

38288

Avenu SLS Holdings, LLC 5860 Trinity Parkway Suite 120 Centreville, VA 20120

27120 29424

A 1,000,000

X X 83 UUN AA6800 1/24/2021 1/24/2022 300,000

10,000

1,000,000 2,000,000 2,000,000

1,000,000B

X X 83 UUN AA6800 1/24/2021 1/24/2022

10,000,000C

83 RHU AA6623 1/24/2021 1/24/2022 10,000,000

10,000 C

X 83 WE AE7C2X 1/24/2021 1/24/2022 1,000,000

1,000,000 1,000,000

Arizona Department of Administration and the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are included as additional insureds (on a primary and non contributory basis) with respect to General Liability and Auto Liability where required by written contract with the named insured. A waiver of subrogation is in favor of the additional insureds with respect to General Liability, Auto Liability, and Workers Compensation where required by written contract with the named insureds. Endeavor to provide thirty (30) days prior written notice in the event of cancellation. Ten (10) days prior written notice in the event of non-payment of premium

Arizona Department of Administration State Procurement Office 100 N 15th Ave., Suite 402 Phoenix, AZ 85007

GOVEREV-01 ZWALSH

Thompson Flanagan Executive Liability Group 626 W. Jackson Blvd. 5th Floor Chicago, IL 60661

Colleen Sokolowski csokolowski@thompsonflanagan.com

HARTFORD INSURANCE SERVICES

Trumbull Insurance Company Hartford Casualty Insurance Company

X

X X

X

X

X

X

X

Attachment 5-C - Supplement 1 - Certificate of Insurance

FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE

FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

ACORD 101 (2008/01)

AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

© 2008 ACORD CORPORATION. All rights reserved.

Thompson Flanagan Executive Liability Group

GOVEREV-01

SEE PAGE 1

SEE PAGE 1

ACORD 25 Certificate of Liability Insurance

SEE P 1

Avenu SLS Holdings, LLC 5860 Trinity Parkway Suite 120 Centreville, VA 20120

SEE PAGE 1

ZWALSH

Named Insured:

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