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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 />