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ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/ODr/YYY) <br />10/24/2024 <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 />Twin Lakes Insurance Agency <br />PO BOX 970 <br />CONTACT <br />NAME: Tana Talbott <br />PHONE No .816-251-3316 FAX No:816-525-4049 <br />fAJC.E-MAIL <br />DOREss: fan a Nnlakesins.com <br />Lees Summit MO 64063 <br />INSURERS AFFORDING COVERAGE <br />NAICa <br />INSURERA: Philadelphia Insurance <br />23850 <br />INSURED CHALSPO-01 <br />Challenger Sports Corp <br />8263 Flint Street <br />INSURER B: Technology Insurance Company Inc <br />42376 <br />INSURER c: State Automobile Mutual Ins CO <br />2$135 <br />INSURER o: Evanston Insurance Company <br />35378 <br />Lenexa KS 66214 <br />INSURER E : <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 939337607 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 />ADOL <br />JUM <br />BUBB <br />IWO <br />POLICY NUMBER <br />POLICYEFF <br />MM/DDIYYNYI <br />POLICYE%P <br />(MWODrl`YYYI <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 1 OCCUR <br />Y <br />PHPK2663995 <br />3/l/2024 <br />3/1/2025 <br />EACH OCCURRENCE <br />$1,000.000 <br />DAMAGE TO RENTED <br />PREMISES Eaoccunence <br />$100,000 <br />MED EXP Any one person) <br />$ 0 <br />PERSONAL S ADV INJURY <br />$1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$3,000,000 <br />X POLICY PEA FILOC <br />PRODUCTS. COMPIOPAGG <br />$3.000.000 <br />X OTHER: SEXUALABUSE <br />LIMIT <br />$1,000,000 <br />C <br />AUTOMOBILE <br />LIABILITY <br />10161716CA <br />1/21/2024 <br />1/21/2025 <br />COMBINED SINGLE LIMIT <br />We accident <br />g1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED X SCHEOULEO <br />AUTOS ONLY AUTOS <br />IAUTOS <br />BODILY INJURY Per accitlant <br />( ) <br />$ <br />X <br />HIRED X NONOWNED <br />ONLY AUTOS ONLY <br />PROPERTYDAMAGE <br />Per accident <br />$ <br />8 <br />D <br />X <br />UMBRELLALIAB <br />X <br />OCCUR <br />XOBW9949724 <br />3/1/2024 <br />3/1/2025 <br />EACH OCCURRENCE <br />$5,000,000 <br />AGGREGATE <br />$5,000,000 <br />E%CE55 LIAB <br />CLAIM' -MADE <br />DED I X I RETENTION$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />TWIC439fiB52 <br />3/1/2024 <br />3/1/2025 <br />X STATUTE ERH <br />E.L. EACH ACCIDENT <br />$1,000.000 <br />ANYPROPRIETOR/PARTNEWEXECUTIVE [E] <br />OFFICERIMEMBEREXCLUDED? <br />NIA <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000.000 <br />(Mandatory In NH) <br />H yes, describe under <br />DESCRIPTION OF OPERATIONS bWlav <br />E.L. DISEASE -POLICY LIMIT <br />$1,000,000 <br />A <br />A <br />Sexual Abuse/Molestatlon <br />Accident Participant Medical Gov <br />PHPK2663995 <br />PHPA148063 <br />3/1/2024 <br />1/2/2024 <br />3/1/2025 <br />1/1/2025 <br />AGGREGATELIMIT <br />LIMIT <br />2,000,000 <br />25,000/25,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be adachad if more space is required) <br />CERTIFICATE HOLDER IS NAMED AN ADDITIONAL INSURED WITH RESPECT TO THEIR INTEREST IN THE LIABILITY ARISING FROM THE <br />OPERATIONS OF THE NAMED INSURED <br />APPROVED <br />By Cynthia Mora at 7:46 am, Dec 23, 2024 <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attention: Parks, Recreation, and Community Servic <br />AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza M-23 <br />Santa Ana CO 92702 <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />