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Home My WebLink AboutUNIVERSAL PROTECTION SERVICES, LP (DBA ALLIED UNIVERSAL SECURITY SERVICES) (2)INSURANCE ON FILE MAY 2 0 2029 WORK MAY PROCEED UNTIL I SURANCE EXPIRES I -2a MAYOR CLERK OF COUNCIL Vicente SarmhAttbE: MAYOR PRO TEM David Penaloza COUNCILMEMBERS Phil Became Johnathan Ryan Hernandez Jessie Lopez Nelida Mendoza Thai Viet Phan 0: PWf1 U)Ct WfF fp- CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza . P.O. Box 1988 Santa Ana, California 92702 ww"s.santa-ana.oro 17141647-3320 February 16, 2021 Universal Protection Service, LP dba Allied Universal Security Services 1551 N. Tustin Ave, Suite 650 Santa Ana, CA 92705 Attn: Steve Claton, President A-2017-130-02 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Re: Extension of Agreement to Provide Security Guard Services, No. A-2017-130 Pursuant to Section 3 ("Term") of the above Agreement, entered into by Allied Universal and the City of Santa Ana, dated May 16, 2017 and as amended by Nos. A-2017-351, A-2019-080, A- 2019-093, and A-2020-209, the time period of the Agreement, as amended, is hereby extended for an additional one (1) year period, from June 1, 2021 through May 31, 2022. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement, as amended, remain unchanged and in full force and effect. Sincerely, Nabil Saba Executive Director Public Works Agency CITY OF SANTA ANA Kiisfrie Ridge City Manager his 1 / Daisy Gomez /� Clerk of the Council APPROVED AS TO FORM ALLIED UNIVERSAL SECURITY JdKn M. Funk Name: OV SA4 F Sr. Assistant City Attorney Title: C.,.Ew&Aj u- M1sNrt 7eA SANTA ANA CITY COUNCIL VPM. Senn... 0.vd Penelam Thel Vlel Phen Jeaele L,pe Phll Bedene Johnatan Ryan Hemandel N.M. Mendeea Meyar Mayor Pm Tem, WaN 2 WaM1 WeN3 Wam4 Werd5 W.W6 Y58n110nM1®Sdn -am IohanPdaana ale 0m Ie98lebPei(&68nYJna.Om 0,,,MeW,,ne om jryennpmendel(dun e-d nmendov�4ame-ana om Digitally signed by Francine R. Francine R. Villareal Villareal A� " CERTIFICATE OF LIABILITY INSURANCE °0T242022°"�"' 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). PRODUCER MARSH USA INC 1717 Arch Street CONTACT Marsh U.S.Operations NAME: AICO NE No Ext: 866-966-4664 A/c, No): E-MAIL Philadelphia.Certs@marsh.com ADDRESS: Philadelphia, PA 19103 Attn: Philadelphia.certs@marsh.com / Fax: (212) 948-0360 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Indian Harbor Insurance Company 36940 CN118025105-ALL-STAND-22-23 INSURED Allied Universal Topco, LLC INSURER B : Greenwich Insurance Company 22322 INSURER C : XL Insurance America 24554 (See Attached for Additional Named Insureds) INSURER D : National Fire & Marine Insurance Company 20079 161 Washington Street, Suite 600 Conshohocken, PA 19428 INSURER E : N/A N/A INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-006447772-26 REVISION NUMBER: 12 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY RES943799402 01/01/2022 01/01/2023 EACH OCCURRENCE $ 30,000,000 CLAIMS -MADE 1XI OCCUR DAMAGE TO PREMISES( a occurrDence $ 30,000,000 X MED EXP (Any one person) $ CONTRACTUAL LIABILITY X SIR $1,750,000 PERSONAL & ADV INJURY $ 30,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 40,000,000 POLICY ❑ JECT PRO [X]LOC X PRODUCTS - COMP/OP AGG $ 40,000,000 $ OTHER: B AUTOMOBILE LIABILITY RAD943781805 01/01/2022 01/01/2023 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB X OCCUR 42XSF10009009 01/01/2022 01/01/2023 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 EXCESS LAB CLAIMS -MADE Excess of General Liability, Auto Liability, and Workers' Comp DED RETENTION $ $ C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) NIA RWD3001203-06(AOS) RWR300120406(WI) 01/01/2022 01/01/2022 01/01/2023 01/01/2023 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liability RES943799402 01/01/2022 01/01/2023 Limit 2,000,000 SIR 1,750,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insured where required by written contract with respect to General Liability and Auto Liability. Liability coverage shall be primary and non-contributory where required by written contract. Waiver of subrogation is applicable where required by written contract. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE µ F\° �y��i3R�� ILLMwag't'.Ih1ed Di isiun �fl' REVIEWED & APPROVED BY: @ 1988-2016 ACORD C }r7 x -` ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD _ Risk Management Analyst AGENCY CUSTOMER ID: CN118025105 LOC #: Philadelphia AGENCY MARSH USA INC POLICY NUMBER CARRIER ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page 2 of 2 NAIC CODE NAMED INSURED Allied Universal Topco, LLC (See Attached for Additional Named Insureds) 161 Washington Street, Suite 600 Conshohocken, PA 19428 EFFECTIVE DATE: Named Insured: Michael Stapleton Associates, Ltd., dba MSA Allied Universal Topco LLC Security Millard Mail Services Holdco LLC Additional Named Insured- MSA Investigations, Inc. Adesta LLC MSA Security, Inc. Advent Systems, LLC MSA Security Canada Limited Advent Systems, LLC, dba Allied Universal MSA Security Limited Technology Services KAKI Cleaning Services, LLC Allied Security Holdings LLC Peoplemark, Inc. Allied Universal Compliance and Investigations, RONCO Consulting Corporation Inc. SecurAmerica, LLC Allied Universal Compliance and Investigations, Securadyne Systems Intermediate LLC Inc., fka G4S Compliance & Investigations, Inc. Securadyne Systems Intermediate LLC, dba Allied Universal Executive Protection and Allied Universal Technology Services Intelligence Services, Inc. Securadyne Systems Texas LLC Allied Universal Finance Corporation Securadyne Systems Texas LLC, dba Allied Allied Universal Holdco LLC Universal Technology Services Allied Universal Risk Advisory and Consulting SFI Electronics, LLC Services, Inc. SFI Electronics, LLC, dba Allied Universal Allied Universal Sideco, LLC Security Systems AlliedBarton (NC) LLC SF1 Electronics, LLC, dba Allied Universal AJIiedBarton (NC) LLC, dba Allied Universal Technology Services Security Services SFI Electronics, LLC, dba Universal Protection AlliedBarton Security Services LLC Security Systems AJIiedBarton Security Services LLC, dba Allied SOS Security LLC Universal Security Services SOS Security LLC, dba Allied Universal Risk AMAG Technologies, Inc. Advisory and Consulting Services American Security Programs, Inc. SOS Security LLC, dba Allied Universal Security Central Defense Services, LLC Services ERMC LLC Spectaguard Acquisition LLC ERMC of America, LLC Staff Pro Inc. FJC Security Services, Inc. Staff Pro Inc., dba Allied Universal Event FJC Security Services, Inc., dba Allied Universal Services Security Services Titania Insurance Co. of America G4S Holding: One LLC TMG Facilities Management, LLC G4S Retail Solutions (Canada) Inc. Ul.S. Security Associates Holding Corp. G4S Retails Solutions (USA) Inc. Universal Building Maintenance, LLC G4S Secure Integration LLC Universal Building Maintenance, LLC, dba Allied G4S Secure Integration LLC dba Allied Universal Janitorial Services Universal Technology Services Universal Building Maintenance, LLC, dba Allied G4S Secure Solutions International Inc. Universal Landscaping Services G4S Secure Solutions (USA) Inc. Universal Protection GP, Inc. G4S Secure Solutions (USA) Inc., dba Allied Universal Protection Security Systems, LP Universal Universal Protection Security Systems, LP, dba G4S Technology Software Solutions LLC Allied Universal Security Systems Intelligent Access Systems of North Carolina, Universal Protection Security Systems, LP, dba LLC Allied Universal Technology Services Intelligent Access Systems of North Carolina, Universal Protection Service of Canada LLC, dba Allied Universal Technology Services Corporation Intelligent Access Systems of North Carolina, Universal Protection Service of Canada LLC, dba Securadyne Systems Mid -Atlantic Corporation, dba Allied Universal Security Michael Stapleton Associates, Ltd. Services of Canada ep ..cF RAMwagmedDMsiun Jy? N,�q REVIEWED & APPROVED BY.- VX*vd RtWjanagementftalpt Universal Protection Service of Canada Corporation, dba Allied Universal Technology Services Universal Protection, Service of Seattle, LLC Universal Protection Service of Seattle, LLC, dba Allied Universal Security Services Universal Protection Service, LLC Universal Protection, Service, LLC, dba Allied Universal Risk Advisory and Consulting Services Universal Protection Service, LLC, dba Allied Universal Security Services Universal Protection Service, LLC, dba Allied Universal Security Services, LLC Universal Protection Service, LP Universal Protection Service, LP, dba Allied Universal Risk Advisory and Consulting Services Universal Protection, Service, LP, dba Allied Universal Security Services Universal Protection Service, LP, dba Allied Universal Security Services, LP Universal Services of America, LP Universal Services of America, LP, dba Allied Universal Universal Thrive Technologies, LLC Universal Thrive Technologies, LLC, dba Allied Universal Monitoring and Response Center Universal Thrive Technologies, LLC, dba Allied Universal Technology Services Universal Thrive Technologies, LLC, dba Thrive Intelligence USAGM Acquisition, LLC cF RAMwagmedDMsiun Jy? N,�q REVIEWED & APPROVED BY.- VX*vd RtWjanagementftalpt XIC 414 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. F--1 Q 01111111541 IR This endorsement modifies insurance provided under the following:: A With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. =ff r7 Additional Insured(s) Work Any person or organization you have agreed to All Operations I include as an additional insured under written contract, provided such contract was executed prior to the date of loss. COVERED AUTOS LIABILITY COVERAGE, Who Is An, Insured, is amended to include as an "insured" the person or organization listed in the Schedule above, but only with respect to liability for "bodily injury" or "property damage" otherwise covered under this policy caused, in whole or in part, by the negligent acts or omissions of: 1. You, while using a covered "auto"; or 2. Any other person, except the additional insured or any employee or agent of the additional insured, operating a covered "auto" with your permission; in the performance of your work as described in the Schedule above. In no event shall any person or organization listed in the Schedule become an "insured" pursuant to this Endorsement if such person or organization is solely negligent. IT IS FURTHER AGREED THAT IN NO EVENT SHALL ANY CONTRACT OR AGREEMENT ALTER THE CONDITIONS, COVERAGES OR EXCLUSIONS SET FORTH IN THIS POLICY. All other terms and conditions of this policy remain unchanged. XIC 414 1013 @ 2013 X.L. America, Inc. All Rights Reserved. ep .. RAMwagmedDMsiun VHAR 02/01/2021 May not be copied without permission. Jy,�q REVIEWED & APPROVED BY.- F04c.�" z *wl Includes copyrighted material of Insurance Services Office, Inc., with its permis.� vx W.WjanagementAnalyst POLICT N11MBER: RAD943781805 C 0 11M E PXA-A"A f, T'- CA 04 44 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS, OF RECOVERY AGAI�NS,T'OTIHE,RS TO US (WAIVER OF SUBROGAT!ION) This endorsement modifies insurance provided under the following: FAIIIII EON 111MIUM.-WOT410:9 'ITTAT01 affoy.-I ky, 1-del.-Ijil A 1111SX4101vul 4= MR With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception, date of the policy unless another date is indicated below. Named Insured: ALLIED UNIVERSAL TOPCO, LLC Endorsement Effective Date: January 1, 2022 9100411u" Name(s) Of Person(s) Or Organ ization(s): Any person or organization where waiver of our right to recover is required by written contract with such person or organization provided such contract was executed prior to the date of loss. I information required to complete this Schedule, if not shown above, will be shown in the Declarations. I The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the persons) or organization,(s) shown in, the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 @ Insurance Services Office, Inc., 2011 ep ..cF RAMwagmedDMsiun ke 77 N,�q REVIEWED & APPROVED BY.- FM'r'" P, v&*'Vd RtWjanagementftalpt 4 01 0191;M4Z 14 011 ffi�1111] This endorsement, effective 12:01 AM 01/01/2022 Forms part of policy number: RES943799402 Issued to: ALLIED UNIVERSAL TOPCO, LLC By: INDIAN HARBOR INSURANCE COMPANY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided by the following: EXCESS GENERAL LIABILITY POLICY A. SECTION II - Who Is an Insured is amended to Include as an additional insured a person (s) or organization(s) who is required to be added by written contract or written agreement which does not require that a specific form number be used. B. The insurance provided to additional insureds applies only to "bodily injury", "property damage", "professional liability" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf In the performance of your ongoing operations for the additional insured,- or "your work" performed for that additional insured and included in the "prod ucts-com pleted operations hazard" However: 1. The insurance afforded to such additional insured only applies to the extent permitted by I aw; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: ep ..cF RAMwagmedDMsiun Jy? N,�q REVIEWED & APPROVED BY: F04c.�" z VX*vd RtWjanagementftalpt Required bvthe contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance e shown in the Declarations. D. The additional insured must see to it that: VVmanmnot|#edassoonaopnau±|rab|emfan"ocournenoe"oreffensethmtnnayrmsu|tinada[nn. 2. VVereceive wvrbtennotice mfada|nnor"suit" assoon aspnact|cable; and 3. y\requeszfor defenxeand|ndemnbyof theda|nnor"suit" wiUprom otlybe brought aga|nntany policy issued byanother insurer under which the additional insured also has rights aninsured or E.This insurance |sprimary toand will not seek contribution from any other insurance available toan additional insured under your policy provided that: The additional insured is a Named Insured under such other insurance; and 2. You have agreed |nwriting |nacontract mragreement that this insurance would beprimary and would not seek contribution from any other insurance available to the additional insured. All other terms and conditions remain as written. RtWjanagementftalpt ENDORSEMENT #24 This endorsement, effective 12:01 AM 01/01/2022 Forms part of policy number: RES943799402 Issued to: ALLIED UNIVERSAL TOPCO, LLC By: INDIAN HARBOR INSURANCE COMPANY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the fo I lowi ng: COM M ERCIAL GENERAL LIABI LIITY POLICY SCHEDULE Name of person or Organization - Where required by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) The TRANSFER OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the ""products -completed operations hazard." This waived applies only to the person or organization shown in the Schedule above. All other terms and conditions remain as written. MANUS ep ..cF RAMwagmedDMsiun Jy? N,�q REVIEWED & APPROVED BY: F04c.�" z VX*vd RtWjanagementftalpt WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. 6=- 00 Any person or organization where waiver of our right to recover is required by written contract with such person or organization provided such contract was executed prior to the date of loss. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is requiredi only when this endorsement is issued) subsequent to preparation of the pollicy.) Endorsement Effective Insured Allied Universal Topco, LLC Insurance Company XL Insurance America, Inc. WC 00 03 13 (Ed. 4-84) (c) 1983 National Council on Compensation Insurance. Policy No. Endorsement No. RWD3001203-06 Premium Included Countersigned by cF RAMwagmedDlOisiun Jy? �S,�q REVIEWED & APPROVED BY: VX*vd RtWjanagernentftaly5t 1 11163 L;1 4 LTA 1:1 ► 11 SM This endorsement, effective 12:01 AM 01/01/2022 Forms part of policy number: RES943799402 Issued to: ALLIED UNIVERSAL TOPCO, LLC By: INDIAN HARBOR INSURANCE COMPANY AMENDMENT OF CANCELATION CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY POLICY Section IV — CONDITION #12, Cancellation, is deleted in its entirety and replaced with the following: 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us ad- vance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured, all additional named insureds, and all certificate holder's written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment or premium: or b. 90 days before the effective date of cancellation if we cancel for .any other reason. It is further understood that ninety (90) will be given for material change. 3. We will mail or deliver our notice to the first Named Insured's last mailing ng address known to us. 4. Notice of cancellation lation will state the effective date of cancellation. The policy period will end on that date. S. If this policy is canceled, we will send the Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, earned premium will be calculated In accordance with the customary pro -rats table and procedure, or the Minimum Earned Premium at the inception of the policy shown in of the Declarations, whichever is greater. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. 7. If we decide to non -renew this policy, we will provide the first Named insured with 90-clays written notice. 8. It is further agreed that notice of cancellation or non -renewal will be given, in writing, to the Risk management Department. All other terms and conditions remain as written. ep ..cF RAMwagmedDMsiun Jy? N,�q REVIEWED & APPROVED BY.- VX*vd RtWjanagementftalpt WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 57 ENDORSEMENT# This endorsement, effective 12:01 a.m. forms a part of Policy No. RWD3001203-06 issued to Allied Universal Topco, LLC by XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT This endorsement modifies insurance provided under the following: WORKERS" COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY Ed. 12110 In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity(ies) according to the notification schedule shown below: Number of Days Name of Person(s) or Entity(ies) Mailing, Address: Advanced Notice of Cancellation: Per the most current schedule maintained by 30 Marsh USA Inc. and furnished to AXA XL no less than 45 days prior to the effective date of the cancellation. All other terms and conditions of the Policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured RWD3001203-06 Premium$ Included Allied Universal Topco, LLC Insurance Company Countersigned by XL Insurance America, Inc. WC 99 06 57 Ed. 12/10 @ 2010 X.L. America, Inc. All Rights Reserved May not be copied without permission. ep ..cF RAMw*gmedDMsiun Jy? N,�q REVIEWED & APPROVED BY.- F04c"�" P, VX*vd RtWjanagementftalpt