RUFFIN, DON A. AND ARLENE B. 2 - 2013

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USPTA•1 OP ID: PLC A R® CERTIFICATE OF LIABILITY INSURANCE DATE0611 OIYYYY, 06/16/14 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 pollcy(les) must 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 andorsement(s). PRODUCER Altus Special Group InterContinen(al ins Solutions 175 Federal Street Suite 725 Boston, MA 02110 CONTACT PHONE PAX A1C No E t: AIC, No: RkNo,a: LIMITS INSURER(S) AFFORDING COVERAGE NAIC # Christopher M Price INSURER A: HCC Specialty Insurance Cc 11243 INSURED United States Professional INSURER s: American Insurance Company 21857 Tennis Association, Inc. 3535 Brjarpark Drive, Suite 1 INSURER C: PREMISES (Ea occurrence) $ 500,00 Houston, TX 77042.5233 INSURER 0: INSURER E Q—x ~llq 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. IN7R OF INSURANCE=11. NO 5UBRPOLICYTYPE mat.POLICY NUMBER MMIDWYYYPV POLI wt LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES (Ea occurrence) $ 500,00 A X COMMERCIAL GENERAL LIABILITY S1317001236 12131113 12/31114 CLAIMB-MADE OCCUR MED EXP (Any one penton) $ PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS � COMPIOP AGG $ 2,000,00 $ X POLICY JFCTPRO LOC AUTOMOBILE LIABILITY COMBINED SIN LE LIMIT Ea aocltlent BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED F 1 SCHEQULED AUTOS HIRED AUTOS AUTOS AUTOS PROPERTYDAMAGE $ Peraccldenl X UMBRELLA UAS X OCCUR EACH OCCURRENCE $ 6,000,00 AGGREGATE $ 8,000,00 B0 EXCESS MAB CLAIMS -MADE SSE00015090087 12131113 12131114 DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE❑ OFFICERIMEMBER EXCLUDED? (Mandatory to NH) NIA O SLATITS OER E.L. EACH ACCIDENT $ E.I., DISEASE - EA EMPLOYE $ If yes, deacAbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, hnnore space Is required) ' e Arlene Ruffin 54144. City of Santa Ana, its officers, employees, agents, Fa� volunteers and representatives is named as additional insured when required by written contract. USRTA Members are insured for General Liability for ,�®V v�✓ playing, teaching or officiating in tennis or operating a tennis ball • G machine for practicing or teaching. \\SPE' 9 pttoTrey ststia City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2010 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD