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Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2022.01.2416:35.57 USABOXI-01 08'00' DJONES ACORO°° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 /13/2022 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 CONTACT NAME: PHONE FAX (A/C, No, Ext): (801) 937-6700 (A/C, No):(801) 937-6710 The Buckner Company 6660 S Millrock, Suite #300 Salt Lake City, UT 84121 E-MAILinfo@buckner.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:State National Insurance Company, Inc. 12831 INSURED INSURER B INSURER C USA Boxing, Inc. INSURER D 1 Olympic Plaza Colorado Springs, CO 80909 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR OVE0000013-00 1/1/2022 1/1/2023 ETORENTED PREMISES PREMISES Ea occurrence 1�QQQ�QQQ $ MED EXP (Any oneperson) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY JECT FX LOC PRODUCTS - COMP/OP AGG $ 1,t)t)t),t)t)t) PARTICIPANT LEG $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE ccident Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage applies as respects the operations of USA Boxing and is contingent upon adherence with all rules and guidelines set forth by USA Boxing. Coverage applies to TKO Boxing Club and TKO Youth Foundation. The City of Santa Ana, its officers, officials, employees, and volunteers are Additional Insureds with respect to General Liability per endorsement CG-GL-CW-0133 (12/20). Waiver of Subrogation applies with respect to General Liability per written contract per endorsement #CG-GL-CW-0001 (12/20). Coverage is Primary and Non -Contributory with respect to General Liability per written contract per endorsement (pending issuance). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE Risk Management Division 20 Civic Center Plaza V �CA w cF ,`REVIEWED& RAMwagmentDiVisian APPROVED BY.- Santa Ana 92702 k_/ ; ' ACORD 25 (2016/03) ©1988-2015 ACORD C , The ACORD name and logo are registered marks of ACORD �` Risk Management Analyst