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"u"�^^-"• Villareal Illareal nets: 2022AL141615:57 USABOXI-01U M'66' DJONES '4k CERTIFICATE OF LIABILITY INSURANCE DATD/1'YVVI 11131213/2022 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 endorsements . PRODUCER CONTACT The Buckner Company 6660 S Millrock, Suite #300 Salt Lake City, UT B4121 A/C, No, Ext: 8D1 937-6700 AQC, No: ( ) (801) 937.6710 E-MAIL , info@buckner.com INSURERS AFFORDING COVERAGE NAICp INSURERA: State National Insurance Company, Inc. 12831 INSURED INSURER B: INSURERC: USA Boxing, Inc. INSURER D: 1 Olympic Plaza Colorado Springs, CO 80909 INSUR ER E INSUR ER F COVERAGES CERTIFICATE NIIMRFR- RP"'IcAnNI NIUMPER• 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 TR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF POLICY EXP MMIDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR OVE0000013-00 1/1/2022 1/1/2023 EACH OCCURRENCE 2,000,000 DAMAGE TO RENTED PREMISES Ea occurs 1,000,000 $ MOD EXP An one arson $ Excluded PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY jECT I—xI LOC GENERAL AGGREGATE $ 5,000,000 PRODUCTS-COMP/OPAGG $ 1,000,000 PARTICIPANT LEG $ 1,000,000 OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY PerPerson) ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS EODILY INJURY Per accident $ PROPERTVDAMAGE Per accident $ H RED NON -OWNED A TOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAe CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN AApNY PROPRIETOR/PARTNER/EXECUTIVE ❑ 1MantlEPIIry IM NHREXCLUDEDI It yes, describe under NIA I PER OTH- AT UTE ER E,L, EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below EL, DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace 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 (12120). Waiver of Subrogation applies with respect to General Liability per written contract per endorsement #CG-GL-CW-0001 (12120). Coverage is Primary and Non -Contributory with respect to General Liability per written contract per endorsement (pending issuance). CERTIFICATE HOLDER CANCELLATION 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 Risk Divisicn ^Yp 20 Civic Center Plaza �% v REVIEWED&APPROV®Sr. Santa Ana C 92702 . .. ACORD 25 (2016103) ©1988-2015 ACORD C '�'— The ACORD name and logo are registered marks of ACORD 'Kux kranagemenr An, lysr