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AC o) '1 2712 CERTIFICATE ©F LIABILITY INSURANCE r <br /> ATE27/20fYYYY)026 <br /> ill <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 Phone: (904)354-9020 CONTACT Fax: {sbG)352-1401 NAME: Loritsringhausen <br /> The Monument Sports Group P"CN o E t (SO4)256-&335,301 (A IC.No <br /> 1365 Overbrook Road <br /> E-MAIL Lori@monumentsports.com <br /> ADOREss: <br /> Suite#i 1 ENSURERS AFFORDING COVERAGE <br /> Richmond,Virginia 23220 INSURER A: LIO Insurance Company 020918 <br /> INSURED INSURER B <br /> Beginners Edge Sports Training LLC INSURER C <br /> 29634 North Lake Pleasant Parkway INSURER D <br /> Suite 103-405 — <br /> Peoria,AZ 85383 INSURER E ----- -- <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:5043 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 TYPE OF INSURANCE ADDL SUER POLICY I I POLICY EX? <br /> LTR POLICY NUMBER MMfDOfYYYY r, MMIDINYYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY L101100084183-00 11/5/2025 11/5/2026 1,000,000 <br /> EACH OCCURRENCE 5 <br /> A CLAIMS-MADE 7 OCCUR DAMAGE TO RENTS❑ 101000 <br /> PREMISES Ea or <br /> S <br /> ✓ Inel Participants �/ y MED EXP(Any one person) 5 5,000 <br /> PERSONAL SADV INJURY S 1,000+000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 <br /> ` IPOLICY❑ ❑PRO- 2,000,QOO <br /> JECT LOC PRODUCTS-COMPIOPAGG 5 <br /> OTHER: Abuse/Mol $ 1,000,000 <br /> AUTOMOBILE LIAB ILdTY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED <br /> P BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS I <br /> HIRED NON-OWNED PROPERTYDAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DE❑ RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRIETCRfPARTNEPJEXECUTIVE ❑ E.L.EACH ACCIDENT $ <br /> OFFiCERIMEMBER EXCLUDED? NIA <br /> (Mandatory in i E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under - -- <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Participant Accident L101 100084189-00 11/5/2025 1115/2026 Med me 25,000 <br /> $500 Ded <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> ity of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers. are included as <br /> additional insured per form CG 001 01 04 13. <br /> giver of Subrogation provided if required by written contract per form CC 20 01 04 13. <br /> his certificate is issued in reference to the named insureds operations and subject to the terms, conditions, and <br /> ther provisions of the policies, <br /> CERTIFICATE HOLDER CANCELLATION APPROVED <br /> By To Tran Nguyen at 11:43 am,filar 18;21J26 <br /> Holder's Nature of Interest:Additional Insured <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City Of Santa Ana:Attn:Parks,Recreation,and Community THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Services Agency <br /> 20 Civic Center Plaza AUTHORIZED REP RESENTATIVE <br /> Santa Ana,CA 92701 <br /> O 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />