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Coverage Is Provided In: Policy Number: <br /> Liberty Ohio Security Insurance Company-a stock company �XWS (26)59 98 58 43 1 <br /> Mutual Policy Period: <br /> INSURANCE From 06/23/2025 To 06/23/2026 <br /> Endorsement Period: <br /> NCCI Co. No. IL9291 1 From To <br /> Workers Compensation and I2:0I am standard Time <br /> Employers Liability Insurance Policy at Insured's Mailing Address <br /> Information Page <br /> Named Insured Agent <br /> MATCH POINT TENNIS ACADEMY LLC (949) 334-5330 <br /> ACRISURE, LLC DBA MPX INSURANCE <br /> SERVICES <br /> EXTENSION OF INFORMATION PAGE <br /> ITEM 3 C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: <br /> All states except North Dakota, Ohio,Washington,Wyoming and states designated in Item 3.A. on <br /> the Information Page. <br /> Countersigned by: <br /> Issue Date <br /> To report a claim, call your Agent or 1-844-325-2467 <br /> WC 99 06 83 <br /> 59985843 POLSVCS 280 INSURED COPY 000996 PAGE 37 OF 64 <br />