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MATCPOI-01
<br />MDELAIRE
<br />r
<br />ACOROW CERTIFICATE OF LIABILITY INSURANCE
<br />FMATE (MMIDDIYYYY)
<br />3/24/2025
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (866) 553-2900 (A/C, No):(949) 281-2877
<br />MPX Insurance Services
<br />200 Congress Park Drive, Suite 100
<br />Delray Beach, FL 33445
<br />E-MAIL service@mpxinsurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:Scottsdale Insurance Company
<br />41297
<br />INSURED
<br />INSURER B: Ohio Security Insurance Company
<br />24082
<br />INSURER 7
<br />Match Point Tennis Academy LLC
<br />INSURER 7
<br />800 Cabrillo Park Dr
<br />Santa Ana, CA 92701
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />CPS8067451
<br />9/12/2024
<br />9/12/2025
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100 000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY PRO ❑ LOC
<br />JECT
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />ccident
<br />Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />R/EXECUTIVE
<br />ANY PROPRIETOR/ EXCLUDED?
<br />OF EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />XWS59985843
<br />6/23/2024
<br />6/23/2025
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,UUU
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />General Liab
<br />CPS8067451
<br />9/12/2024
<br />9/12/2025
<br />Sexual $100K / Abuse
<br />300,000
<br />A
<br />General Liability
<br />CPS8067451
<br />9/12/2024
<br />9/12/2025
<br />�Participantinj $25K/
<br />50,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability
<br />arising out of work or operations performed by or on behalf of the Permittee including materials, parts, or equipment furnished in connection with such work
<br />or operations. Waiver of subrogation applies to the General Liability policy per the attached endorsement. Cancellation provisions apply to the General
<br />Liability policy per the attached endorsement. Digitallysigned
<br />Tran APPROVED
<br />TU TPd 11 by TuNguyen
<br />Workers Comp: Owner- Elson De Cantuaria Nguyen
<br />Nguyen Date:2025.04.09 By Tu Tran Nguyen at 3:17 pm, Apr 09, 2025
<br />15:18:02-07'00'
<br />City of Santa Ana
<br />Attention: Parks, Recreation and Community Services
<br />20 Civic Center Plaza, M-23
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Meecedes Dela;re
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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