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HomeMy WebLinkAboutMATCH POINT TENNIS ACADEMY LLC. (3)A-2024-014 INSURANCE ON FILE WORT( MAY PROCEED _ A 2019-2r1 -vi UNTIL INSURANCE EXPIRES Cl [Y CLERK D rE: FEB 2 3 2024 SF.CONU ANIP NI)NIFNT TO AGRVEMI:NT FOR T111,. NIANAGEN1ENT, OPEIZATION, AND NIA1N1 ENANC'E OF THU,, CA11101,1,0 I ENNIS C'I:NTI:R I HIS SECOND AN1FN[);\IFN 1 to the abo\ e-rctcrenccd agreement is entered into on January 16, 2024, by and bcnyccn %latchpoint Tennis Acadcmy L.I.C. a Calilirrnia limited liability company (' \latchpoilIC) and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and kms of the State of ('ahl'Ornia ("City"). RECITALS A. On December [7, 20[9, City and Nlatehpoint entered into Agrecincrlt (A-2019-241 ) for the management, operation, and maintenance of' tile Cabrillo Tennis Center ("Facility") located at 800 N. Cabrillo Park I)rivc, Santa Ana, California ("Agreenlent"). H. On April [, 2020, City and %latehpoint executed a First Amendment (A-2020-060) to the Agreement to alloy foradditional time to complete installation of two (2) clay tennis courts at the Facility because of the closure of the Facility due to the COVID-19 pandemic ("First Aillerldillent"). C . The Agreement remains in effect through December 31, 2034. D. Pursuant to the terms of the .Agreement and First Amendment, N(latchpoint is required to make certain improvements to the Facility, including the installation of two (2) clay tennis courts at the Facility no later than June 30, 2021, one ( I ) center tennis court at the Facility no later than December 3[, 2023, and fencing to be installed around the entire Facility no later than December 31. 2023. E. As a result of the global Coronavirus (COVID-19) pandemic, engineering and constniction progress was delayed for the installation of the clay tennis courts, the installation of the center tennis court, and the installation of the fence around the Facility. F. The parties now wish to amend the Agreement to reduce the term of the .Agreement and adjust the delivery dates associated with the installation of the clay tennis courts, center tennis court, and the fence around the Facility. The Parties therefore agree: I. Section 2.0, TE.IZNI OF AGREEMENT, is hereby amended to reduce the term of thi, .Agreement to ten (10) years from the commencement date of January I, 2020 and shall expire on December 31, 2029, with the option for one ( I ) five (5) year extension exercisable by a writing by the City Nlanagerand City Attorney, unless terminated earlier in conformance �� ith Sections 9 and [0 of the Azreement. 2. Section 4.0, I,NIPIZOVEMENTS TO THE FACT ATIES, subsections 4.[, 4-2, and -1.3 are hereby amended to read as lollows: Pagel of 2 Section 4.1 Operator sh:dl, in connection with its maintenance responsibilities, cause two (2) clay tennis courts ❑, he installed at [lie Facilities in a location determined by the City. The two (_) clay tennis aeuts shall be completed and operational no later than December 31. 2025. All costs association with construction of the two (2) clay tennis courts shall be paid by Operator. Section 4.2 Operator shall, in connection with its maintenance responsibilities cause one (1) center tennis court to be installed at the Facilities in a location determined by the City. The one (1) center tennis court shall be completed and operational no later than December 31, 2026. All costs associated with construction of the one ( I ) center tennis court shall be paid by Operator. Section 4.3 Operator shall, in connection with its maintenance responsibilities cause a fence to be installed around the entire Facilities in a location determined by the City. City will have final approval of the location, material and design of the fence. The fence will be completed no later than December 31, 2027. 3. Except as modified by this Second Amendment, all terns and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to the Agreement on the date and year first written above. ATTEST Jennifer L. I r, APPROVED AS TO FORM SONIA R. CARVALHO, CityAttomey By andon Salvatierra Deputy City Attorney RECOMMENDED FOR APPROVAL Ps4hq� Hawk Scott (Jan II, 202409:58 PST) CITY OF SANTA ANA Aomasatc Interim City Manager Hawk Scott Executive Director Parks, Recreation, and Community Services Agency MATCHPOINT TENNIS ACADEMY, LL; i Name:C(S De r4 ta�trs Title: g4; Vter� rvlauaser Page 2 of 2 SECOND AMENDMENT TO AGREEMENT FOR THE Final Audit Report Created: 2024-01-17 By: Stephanie Garcia (SGarcia5@santa-ana.org) Status: Signed Transaction ID: CBJCHBCAABAA6twEUATOmu2w4g43j35STr11h-9n9kxy 2024-01-17 "SECOND AMENDMENT TO AGREEMENT FOR THE" History Document created by Stephanie Garcia (SGarcia5@santa-ana.org) 2024-01-17- 5:50:23 PM GMT- IP address: 98.153.69,210 L'+ Document emailed to Hawk Scott (hscott@santa-ana.org) for signature 2024-01-17 - 5:50:38 PM GMT Email viewed by Hawk Scott (hscott@santa-ana.org) 2024-01-17 - 5:53:13 PM GMT- IP address: 98.153.69.211 &9 Document e-signed by Hawk Scott (hscott@santa-ana.org) Signature Date: 2024-01-17 - 5:53:23 PM GMT -Time Source: server- IP address: 98.153.69.211 Agreement completed. 2024-01-17 - 5:53:23 PM GMT 0 Adobe Acrobat Sign Garcia, Stephanie From: Sent: To: Subject: Contractor Name: Project Number: Project Name: City of Santa Ana <certificate-request@ctraxjdidata.com> Wednesday, February 14, 2024 12:56 PM decantu2006@yahoo.com, Hoang, Julie; Garcia, Stephanie Internal Notice of Compliance NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Match Point Tennis Academy LLC A-2020-060 First Amendment to Agreement for the Management, Operation and Maintenance of Cabrillo Tennis Center The Certificate of Insurance (COI) submitted indicates that the coverages comply with the insurance requirements. The compliant coverage(s) are: TYPE OF INSURANCE AUTOMOBILE LIABILITY GENERAL LIABILITY POLICY NUMBER WAIVER CPS7653589 EXPIRATION DATE 12/31/2034 09/12/2024 COI DATE FILE NAME 05/30/2023 Untitled Extract Pages.pdf MATCH POINT 01/16/2024 Cert of Ins -City of Santa Ana.PDF WORKERS COMPENSATION AND EMPLOYERS' XWS59985843 06/23/2024 01/16/2024 LIABILITY No further action is required at this time. Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team MATCH POINT Cert of Ins - City of Santa Ana.PDF 2/14/2024 3:56 PM MATCPOI-01 MDELAIRE r ACOROW CERTIFICATE OF LIABILITY INSURANCE FMATE (MMIDDIYYYY) 3/24/2025 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 policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (866) 553-2900 (A/C, No):(949) 281-2877 MPX Insurance Services 200 Congress Park Drive, Suite 100 Delray Beach, FL 33445 E-MAIL service@mpxinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Scottsdale Insurance Company 41297 INSURED INSURER B: Ohio Security Insurance Company 24082 INSURER 7 Match Point Tennis Academy LLC INSURER 7 800 Cabrillo Park Dr Santa Ana, CA 92701 INSURER E 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X X CPS8067451 9/12/2024 9/12/2025 DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE ccident Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N R/EXECUTIVE ANY PROPRIETOR/ EXCLUDED? OF EXCLUDED? (Mandatory in NH) N / A XWS59985843 6/23/2024 6/23/2025 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,UUU If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ A General Liab CPS8067451 9/12/2024 9/12/2025 Sexual $100K / Abuse 300,000 A General Liability CPS8067451 9/12/2024 9/12/2025 �Participantinj $25K/ 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) 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 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 or operations. Waiver of subrogation applies to the General Liability policy per the attached endorsement. Cancellation provisions apply to the General Liability policy per the attached endorsement. Digitallysigned Tran APPROVED TU TPd 11 by TuNguyen Workers Comp: Owner- Elson De Cantuaria Nguyen Nguyen Date:2025.04.09 By Tu Tran Nguyen at 3:17 pm, Apr 09, 2025 15:18:02-07'00' City of Santa Ana Attention: Parks, Recreation and Community Services 20 Civic Center Plaza, M-23 Santa Ana, CA 92702 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 Meecedes Dela;re ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policyholder Information Named Insured & Mailing Address MATCH POINT TENNIS ACADEMY LLC 800 CABRILLO PARK DR SANTA ANA, CA 92701 Dear Policyholder: Agent Mailing Address & Phone No. (949) 334-5330 ACRISURE, LLC DBA MPX INSURANCE SERVICES 160 W Camino Real Unit 523 Ste 200 Boca Raton, FL 33432 We know you work hard to build your business. We work together with your agent, ACRISURE, LLC DBA MPX INSURANCE (949) 334-5330 to help protect the things you care about. Thank you for selecting us. Enclosed are your insurance documents consisting of: To find your specific coverages, limits of liability, and premium, please refer to your Declarations page(s). If you have any questions or changes that may affect your insurance needs, please contact your Agent at (949) 334-5330 Verify that all information is correct If you have any changes, please contact your Agent at (949) 334-5330 Reminders In case of a claim, call your Agent or 1-844-325-2467 You Need To Know . CONTINUED ON NEXT PAGE To report a claim, call your Agent or 1-844-325-2467 DS 70 20 01 21 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B (Ed. 7-01) POLICY INFORMATION PAGE ENDORSEMENT The following item(s) ❑ Insured's Name(WC 89 06 01) ❑ Item 3.13. Limits(WC 89 06 12) ❑ Policy Number(WC 89 06 02) ❑ Item 3.C. States(WC 89 06 13) ❑ Effective Date(WC 89 06 03) ❑ Item 3.D. Endorsement Numbers(WC 89 06 14) ❑ Expiration Date(WC 89 06 04) ❑ Item 4.' Class, Rate, Other(WC 89 04 15) ❑ Insured's Mailing Address(WC 89 06 05) ❑ Interim Adjustment of Premium(WC 89 04 16) ❑ Experience Modification(WC 89 04 06) ❑ Carrier Servicing Office(WC 89 06 17) ❑ Producer's Name(WC 89 06 07) ❑ Interstate/Intrastate Risk ID Number(WC 89 06 18) ❑ Change in Workplace of Insured(WC 89 06 08) ❑ Carrier Number(WC 89 06 19) ❑ Insured's Legal Status(WC 89 06 10) ❑ Issuing Agency/Producer Office Address(WC 89 06 25) ❑ Item 3.A. States(WC 89 06 11) is changed to read: WAIVER OF SUBROGATION IS ADDED TO THE POLICY IN FAVOR OF :City of Santa AnaAttention: Parks, Recreation and Community Services20 Civic Center Plaza, M-23Santa Ana, CA 92702 See Extension of Information Page and any other document. * Item 4. Change To: Classifications Code Premium Basis Total Rate Per Estimated No. Estimated Annual $100 of Annual Remuneration Remuneration Premium See Extension of Information Page Total Estimated Annual Premium $7, 588.00 Total Surcharges and Assessments $459.00 Total Estimated Cost $8, 047.00 Minimum Premium: $859.00 CA Deposit Premium: All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/24/2025 Policy Effective 06/23/2024 State Policy No. XWS (25) 59 98 58 43 Insured MATCH POINT TENNIS ACADEMY LLC Insurance Company Ohio Security Insurance Company WC 89 06 00 B (Ed. 7-01) Endorsement No. 0001 Premium $0.00 19291 Countersigned by: © 2001 National Council on Compensation Insurance, Inc. Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company - a stock company �XWS (25) 59 98 58 43 Mutual Policy Period: INSURANCE From 06/23/2024 To 06/23/2025 Endorsement Period: NCCI Co. No. 1 K I From 03/24/2025 To 06/23/2025 Workers Compensation and 12:01 am StandardTime at Insured'sMailingAddress Employers Liability Insurance Policy Information Page Named Insured Agent MATCH POINT TENNIS ACADEMY LLC (949) 334-5330 ACRISURE, LLC DBA MPX INSURANCE SERVICES EXTENSION OF INFORMATION PAGE ITEM 3 C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except North Dakota, Ohio, Washington, Wyoming and states designated in Item 3.A. on the Information Page. Countersigned by: Issue Date To report a claim, call your Agent or 1-844-325-2467 WC 99 06 83 59985843 POLSVCS 280 INSURED COPY 001231 PAGE 25 OF 30 Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company - a stock company �XWS (25) 59 98 58 43 Mutual Policy Period: INSURANCE From 06/23/2024 To 06/23/2025 Endorsement Period: NCCI Co. No. 19291 I From03/24/2025 To 06/23/2025 Workers Compensation and 12:01 am StandardTime at Insured'sMailingAddress Employers Liability Insurance Policy Information Page Named Insured Agent MATCH POINT TENNIS ACADEMY LLC (949) 334-5330 ACRISURE, LLC DBA MPX INSURANCE SERVICES EXTENSION OF INFORMATION PAGE State: CALIFORNIA ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code Premium Basis - Total Rate per Estimated No. Estimated Annual $100 of Annual Remuneration Remuneration Premium MATCH POINT TENNIS ACADEMY LLC 800 Cabrillo Park Dr Santa Ana, CA 92701-4648 NLC 001 CSN 001 state 04 exp rec link 00001 Clubs - Sports - Including Restaurant Employees Retail Store Employees and Receptionists 9053 266,225.00 2.72 7,241.00 Total Subject Premium 7,241.00 Premium Modified to Reflect Experience Mod. Of 9898 .000 7,241.00 Price Point Modification 9734 debit 1.011 80.00 Total Estimated Annual Standard Premium 7,321.00 WC Expense Constant 0900 160.00 Terrorism 9740 266,225.00 .03 80.00 Catastrophe (Other than Certified Acts of Terror.) 9741 266,225.00 .01 27.00 State Estimated Annual WC Premium 7,588.00 WC Administration Revolving Fund Assessment 0935 2.4604 187.00 Uninsured Employers Benefits Trust Fund Assessment 0937 .1505 11.00 Subsequent Injuries Benefits Trust Fund Assessment 0938 1.5891 121.00 Occupational Safety and Health Fund Assessment 0939 .7266 55.00 Labor Enforcement and Compliance Fund Assessment 0992 .7109 54.00 WC Fraud Account Assessment 9703 .4122 31.00 CIGA Surcharge 0936 .0000 .00 CA Total Cost 8,047.00 Countersigned by: Issue Date To report a claim, call your Agent or 1-844-325-2467 WC 99 06 84 59985843 POLSVCS 280 INSURED COPY 001231 PAGE 27 OF 30 Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company - a stock company IXWS (25) 59 98 58 431 Mutual Policy Period: INSURANCE From 06/23/2024 To 06/23/2025 Endorsement Period: NCCI Co. No. 19291 I From 03/24/2025 To 06/23/2025 Workers Compensation and 12:01 am StandardTime at Insured'sMailingAddress Employers Liability Insurance Policy Information Page Named Insured Agent MATCH POINT TENNIS ACADEMY LLC (949) 334-5330 ACRISURE, LLC DBA MPX INSURANCE SERVICES EXTENSION OF INFORMATION PAGE POLICY FORMS AND ENDORSEMENTS This section lists all the Forms and Endorsements that make up your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE STATE(S) Applicable WC 00 00 00 C Workers Compensation and Employers Liability Insurance Policy CA WC 00 04 21 F Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement CA WC 00 04 22 C Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement CA " WC 04 03 01 D Policy Amendatory Endorsement - California CA WC 04 03 10 Duty To Defend Endorsement - California CA WC 04 03 18 C Limited Liability Company Coverage/Exclusion Endorsement - California CA Endorsement Agreement Limiting and Restricting This Insurance WC 04 03 60 B Employers' Liability Coverage Amendatory Endorsement - California CA WC 04 04 21 Optional Premium Increase Endorsement - California CA WC 04 06 01 B California Cancelation Endorsement CA Countersigned by: Issue Date To report a claim, call your Agent or 1-844-325-2467 WC 99 06 85 59985843 POLSVCS 280 INSURED COPY 001231 PAGE 29 OF 30 POLICY NUMBER: CPS8067451 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations THE CITY OF SANTA ANA, ITS OFFICERS, VARIOUS OFFICIALS, EMPLOYEES, AND VOLUNTEERS 20 CIVIC CENTER PLAZA, SANTA ANA, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Pagel of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: CPS8067451 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): THE CITY OF SANTA ANA, ITS OFFICERS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS 20 CIVIC CENTER PLAZA SANTA ANA CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR AUTOMOBILF LIABILITY INSURANCE � Elson De Cantuaria ('�Amc and Title��t �'cnt1or Rc�+tr�cnt;►tnct Matchpoint Tennis Academy' LLC r���n�:�etlt�iti��c of (Consultant Campan\ Name) possess the authority to legally bind Company. that I am an atithorized 614.any") , and In my capacity as Reprcsentative of Company, I represent and confine the following, as relates to the ai!re meet between Cony pany and Cityf Santa Ana, cigreement nnt�� r "At!reemeet'') to provicue A-2019-241 Management, operation, and maintenance of the C-it)rdlo Tennis Center Services"): (Services to be pro%. tdcd under agreement contract) During the course and scope of Company's agreement with the City of Santa Ana, Company employees, consultants, representatives, and agents will not use and/or drive any Company owned/rentedlleased/ borrowed vehicles to perform Services to, for, or on behalf of City of Santa Ana. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum automobile liability 111Surance coverage as required in the Agreement, it will be considered a breach of Agreement renderincy the Agreement null and �'40•o� and Company grill be fully liable for any and all damages. Signature Elson De Cantuaria Print Name Owner/Manager J ItIc 714-724-9407 / d eca ntu2006 @yahoo. com -�-- Contact Inf'urr anon, i.e,, Telephone Number and./or Emad Address 000 "3 /C2-C;L/ C Date Affidavit of Exemption for Automobile Liability Insurance 11.12-2024 MATCPOI-01 ESARAIVA ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/17/2025 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 policy(ies)must have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT NAME: MPX Insurance Services PHONE FAX 200 Congress Park Drive,Suite 100 (A/C,No,Ext):(866)553-2900 (A/C,No):(949)281-2877 Delray Beach, FL 33445 E-MAIL service@mpxinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Scottsdale Insurance Company 41297 INSURED INSURER B:Ohio Security Insurance Company 24082 Match Point Tennis Academy LLC INSURER 7 800 Cabrillo Park Dr INSURER 7 Santa Ana,CA 92701 INSURER E 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPS8284857 9/12/2025 9/12/2026 rl DAMAGE TO RENTED 100 000 X X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N XWS59985843 6/23/2025 6/23/2026 1,000,000 ANY PROPRIETOR/EXCLUDED? R/EXECUTIVE N/A E.L.EACH ACCIDENT $ OF EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,ODU If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A General Liability CPS8284857 9/12/2025 9/12/2026 Sexual$100k/Abuse 300,000 A General Liability CPS8284857 9/12/2025 9/12/2026 Participant Inj $25k 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) 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 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 or operations.Waiver of subrogation applies to the General Liability policy per the attached endorsement.Cancellation provisions apply to the General Liability policy per the attached endorsement. Tu Tran Digitally signed by Tu Tran Nguyen Workers Comp:Owner-Elson De Cantuaria Date:2025.09.22 Nguyen 13:56:48-07'00' APPROVED By Tu Tran Nguyen at 1:56 pm,Sep 22,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Attention:Parks, Recreation and Community Services 20 Civic Center Plaza, M-23 Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Liberty Mutual INSURANCE Policyholder Information Named Insured&Mailing Address Agent Mailing Address&Phone No. MATCH POINT TENNIS ACADEMY LLC (949) 334-5330 800 CABRILLO PARK DR ACRISURE, LLC DBA MPX INSURANCE SANTA ANA, CA 92701 SERVICES 160 W Camino Real Unit 523 Ste 200 Boca Raton, FL 33432 Dear Policyholder: We know you work hard to build your business. We work together with your agent, Your ACRISURE, LLC DBA MPX INSURANCE (949) 334-5330 Commercial to help protect the things you care about. Thank you for selecting us. Documents Enclosed are your insurance documents consisting of: • Workers Compensation And Employers Liability Insurance Policy, Information Page, Endorsements and Other Documents To find your specific coverages, limits of liability and premium, please refer to your Workers Compensation and Employers Liability Insurance Policy Information Page, extensions, the policy and endorsements. If you have any questions or changes that may affect your insurance needs, please contact your Agent at (949) 334-5330 Verify that all information is correct If you have any changes, please contact your Agent at (949) 334-5330 Reminders In case of a claim, call your Agent or 1-844-325-2467 You Need To Know . CONTINUED ON NEXT PAGE To report a claim, call your Agent or 1-844-325-2467 DS 70 20 0121 You Need To Know - continued . NOTICE(S) TO POLICYHOLDER(S) The Important Notice(s) to Policyholder(s) provide a general explanation of changes in coverage to your policy. The Important Notice(s) to Policyholder(s) is not a part of your insurance policy and it does not alter policy provisions or conditions. Only the provisions of your policy determine the scope of your insurance protection. It is important that you read your policy carefully to determine your rights, duties and what is and is not covered. FORM NUMBER TITLE CNI90 11 07 18 Reporting A Commercial Claim 24 Hours A Day CNI90 20 08 21 Important Notice Circumstances Adversely Impacting Credit History CNI90 24 08 22 Information About Your Policy NP 74 44 09 06 U.S. Treasury Department's Office of Foreign Assets Control (OFAC) Advisory Notice to Policyholders NP 91 89 02 13 Important Information Consumer Affairs Policyholder Notice NP 91 91 08 24 Important Policyholder Information Concerning Billing Practices - California PN 04 99 04 California Insurance Guarantee Association (CIGA) Surcharge SNW04 08 07 18 Policyholder Notice - California Assembly Bill (AB) 2883 and Senate Bill (SB) 189 SNW04 10 07 18 General Partners And LLC Managing Members - Waiver Of Workers' Compensation Coverage SNW04 11 04 18 California Risk Control Services SNW04 13 01 18 Managed Care Notification Policyholder Notice California Senate Bill (SB) 1160 - SNW04 14 06 24 Liberty Mutual Privacy Notice SNW04 16 02 22 Policyholder Notice Your Right to Rating And Dividend Information SNW04 17 06 20 Policyholder Notice California Workers' Compensation Insurance Rating Laws SNW90 03 07 18 Clarification of Other States Coverage . This Workers Compensation and Employees Liability policy is auditable. Please refer to the conditions of the policy for details or contact your agent. . This policy will be direct billed. You may choose to combine any number of policies on one bill with your billing account. Please contact your agent for more information. Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company-a stock company �XWS (26)59 98 58 43 1 Mutual Policy Period: INSURANCE From 06/23/2025 To 06/23/2026 Endorsement Period: NCCI Co. No. IL9291 1 From To Workers Compensation and I2:0I am standard Time Employers Liability Insurance Policy at Insured's Mailing Address Information Page Named Insured Agent MATCH POINT TENNIS ACADEMY LLC (949) 334-5330 ACRISURE, LLC DBA MPX INSURANCE SERVICES EXTENSION OF INFORMATION PAGE ITEM 3 C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except North Dakota, Ohio,Washington,Wyoming and states designated in Item 3.A. on the Information Page. Countersigned by: Issue Date To report a claim, call your Agent or 1-844-325-2467 WC 99 06 83 59985843 POLSVCS 280 INSURED COPY 000996 PAGE 37 OF 64 Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company-a stock company �XWS (26)59 98 58 43 1 Mutual Policy Period: INSURANCE From 06/23/2025 To 06/23/2026 Endorsement Period: NCCI Co. No. IL9291 1 From To Workers Compensation and 12:01 am standard Time Employers Liability Insurance Policy at Insured's Mailing Address Information Page Named Insured Agent MATCH POINT TENNIS ACADEMY LLC (949) 334-5330 ACRISURE, LLC DBA MPX INSURANCE SERVICES EXTENSION OF INFORMATION PAGE State:CALIFORNIA ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code Premium Basis-Total Rate per Estimated No. Estimated Annual $100 of Annual Remuneration Remuneration Premium MATCH POINT TENNIS ACADEMY LLC 800 Cabrillo Park Dr Santa Ana, CA 92701-4648 NLC 001 CSN 001 state 04 exp rec link 00001 Clubs - racquet sports - including restaurant, bar or tavern employees, retail store employees and receptionists 9053 266,225.00 2.70 7, 188.00 Total Subject Premium 7, 188.00 Price Point Modification 9734 debit 1.011 79.00 Total Estimated Annual Standard Premium 7,267.00 WC Expense Constant 0900 160.00 Terrorism 9740 266,225.00 .03 80.00 Catastrophe (Other than Certified Acts of Terror.) 9741 266,225.00 .01 27.00 State Estimated Annual WC Premium 7,534.00 WC Administration Revolving Fund Assessment 0935 1.2370 93.00 Uninsured Employers Benefits Trust Fund Assessment 0937 .0818 6.00 Subsequent Injuries Benefits Trust Fund Assessment 0938 3.0148 227.00 Occupational Safety and Health Fund Assessment 0939 . 1885 14.00 Labor Enforcement and Compliance Fund Assessment 0992 . 1058 8.00 WC Fraud Account Assessment 9703 .4096 31.00 CIGA Surcharge 0936 .0000 .00 CA Total Cost 7,913.00 Countersigned by: Issue Date To report a claim, call your Agent or 1-844-325-2467 WC 99 06 84 59985843 POLSVCS 280 INSURED COPY 000996 PAGE 39 OF 64 Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company-a stock company �XWS (26)59 98 58 43 1 Mutual Policy Period: INSURANCE From 06/23/2025 To 06/23/2026 Endorsement Period: NCCI Co. No. IL9291 1 From To Workers Compensation and I2:0I am standard Time Employers Liability Insurance Policy at Insured's Mailing Address Information Page Named Insured Agent MATCH POINT TENNIS ACADEMY LLC (949) 334-5330 ACRISURE, LLC DBA MPX INSURANCE SERVICES EXTENSION OF INFORMATION PAGE POLICY FORMS AND ENDORSEMENTS This section lists all the Forms and Endorsements that make up your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE STATE(S)Applicable WC 00 00 00 C Workers Compensation and Employers Liability Insurance Policy CA WC 00 04 21 F Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement CA WC 00 04 22 C Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement CA WC 04 03 01 D Policy Amendatory Endorsement - California CA WC 04 03 10 Duty To Defend Endorsement - California CA WC 04 03 18 C Limited Liability Company Coverage/Exclusion Endorsement - California CA Endorsement Agreement Limiting and Restricting This Insurance WC 04 03 60 B Employers' Liability Coverage Amendatory Endorsement - California CA WC 04 04 21 Optional Premium Increase Endorsement - California CA WC 04 06 01 B California Cancelation Endorsement CA Countersigned by: Issue Date To report a claim, call your Agent or 1-844-325-2467 WC 99 06 85 59985843 POLSVCS 280 INSURED COPY 000996 PAGE 41 OF 64 A� SCOTTSD.ALE INSURANCE COMPANYO COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS Policy No. CPS8284857 Effective Date 09/12/2025 MATCH POINT TENNIS ACADEMY, 12:01 A.M., Standard Time Named Insured LLC Agent No. 04027 Item 1. Limits of Insurance Coverage Limit of Liability Aggregate Limits of Liability Products/Completed $ 2,000,000 Operations Aggregate General Aggregate (other than $ 2,000,000 Products/Completed Operations) Coverage A—Bodily Injury and any one occurrence subject Property Damage Liability to the Products/Completed Operations and General $ 1,000,000 Aggregate Limits of Liability any one premises subject to the Coverage A occurrence and the General Aggregate Limits Damage to Premises Rented to You Limit $ 100,000 of Liability Coverage B—Personal and any one person or organization Advertising Injury Liability subject to the General Aggregate $ 1, 000,000 Limits of Liability Coverage C—Medical Payments any one person subject to the Coverage A occurrence and the General Aggregate Limits $ 5, 000 Item 2. Description of Business Form of Business: ❑ Individual ❑ Partnership ❑ Joint Venture ❑ Trust ❑ Limited Liability Company ❑ Organization including a corporation (other than Partnership, Joint Venture or Limited Liability Company) Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE OF LOCATIONS Item 3. Forms and Endorsements Form(s) and Endorsement(s) made a part of this policy at time of issue: See Schedule of Forms and Endorsements Item 4. Premiums Coverage Part Premium: $ $3,233 Other Premium: $ Total Premium: $ $3,233 THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. CLS-SD-1L(8-01) ASCOTTSDALE INSURANCE COMPANY' COMMERCIAL GENERAL LIABILITY COVERAGE PART EXTENSION OF SUPPLEMENTAL DECLARATIONS Policy No. CPS8284857 Effective Date: 09/12/2025 12:01 A.M., Standard Time Named Insured MATCH POINT TENNIS ACADEMY, LLC Agent No. 04027 Prem. No. Bldg. No. Class Code Exposure Basis 1 1 40066 14 PER GAME/EACH Class Description: Premises/Operations ATHLETIC LEAGUES RATED AS ATHLETIC PROGRAMS - Rate Premium AMATEUR - OTHER THAN NOT-FOR-PROFIT $19.91 $279 Products/Comp Operations Rate Premium Prem. No. Bldg. No. Class Code Exposure Basis 1 1 49890 150 PER REGISTRANT/EACH Class Description: Premises/Operations SPORTS CLINICS RATED AS YOUTH RECREATION PROGRAMS Rate Premium - OTHER THAN NOT-FOR-PROFIT $15.36 $2,304 Products/Comp O erations Rate Premium Prem. No. Bldg. No. Class Code Exposure Basis 1 1 48924 7,800 PER $1,000 / GROSS SALES Class Description: Premises/Operations SPORT COURT - COMMERCIALLY OPERATED RATED AS Rate Premium SWIMMING POOLS/RACQUETBALL - COMMERCIALLY OPERATED 83 .31 650 + PRODUCTS/COMPLETED OPERATIONS ARE SUBJECT TO THE Products/Comp Operations GENERAL AGGREGATE LIMIT Rate Premium INCLUDED INCLUDE Prem. No. Bldg. No. Class Code Exposure Basis 44444 Class Description: Premises/Operations SEXUALLY ABUSIVE ACTS - LIMITED LIABILITY COVERAGE Rate Premium PER FORM GLS-621 INCLUDED INCLUDE Products/Comp Operations Rate Premium CLS-SP-1 L(10-93) ASCOTTSDALE INSURANCE COMPANY' COMMERCIAL GENERAL LIABILITY COVERAGE PART EXTENSION OF SUPPLEMENTAL DECLARATIONS Policy No. CPS8284857 Effective Date: 09/12/2025 12:01 A.M., Standard Time Named Insured MATCH POINT TENNIS ACADEMY, LLC Agent No. 04027 Prem. No. Bldg. No. Class Code Exposure Basis 44444 FLAT CHARGE Class Description: Premises/Operations COMPETITIVE ATHLETIC OR SPORTS PARTICIPANTS - Rate Premium LIMITED LIABILITY COVERAGE PER FORM GLS-736 INCLUDED INCLUDE Products/Comp Operations Rate Premium Prem. No. Bldg. No. Class Code Exposure Basis 49950 1 INCLUDED Class Description: Premises/Operations PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE Rate Premium CONDITION PER FORM CG 20 01 INCLUDED INCLUDE Products/Comp O erations Rate Premium Prem. No. Bldg. No. Class Code Exposure Basis 49950 3 INCLUDED Class Description: Premises/Operations ADDITIONAL INSURED - OWNER, LESSEE OR CONTRACTOR - Rate Premium SCHEDULED PERSON OR ORGANIZATION PER FORM CG 20 10 INCLUDED INCLUDE Products/Comp Operations Rate Premium Prem. No. Bldg. No. Class Code Exposure Basis 44444 2 INCLUDED Class Description: Premises/Operations WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST Rate Premium OTHERS TO US (WAIVER OF SUBROGATION) PER FORM CG 24 04 INCLUDED INCLUDE Products/Comp Operations Rate Premium CLS-SP-1 L(10-93) ASCOTTSDALE INSURANCE COMPANY' COMMERCIAL GENERAL LIABILITY COVERAGE PART EXTENSION OF SUPPLEMENTAL DECLARATIONS Policy No. CPS8284857 Effective Date: 09/12/2025 12:01 A.M., Standard Time Named Insured MATCH POINT TENNIS ACADEMY, LLC Agent No. 04027 Prem. No. Bldg. No. Class Code Exposure Basis 49950 1 INCLUDED Class Description: Premises/Operations ADDITIONAL INSURED - CLUB MEMBERS PER FORM CG 20 Rate Premium 02 INCLUDED INCLUDE Products/Comp Operations Rate Premium Prem. No. Bldg. No. Class Code Exposure Basis 49950 1 INCLUDED Class Description: Premises/Operations BLANKET ADDITIONAL INSURED ENDORSEMENT PER FORM Rate Premium GLS (HI) 150S INCLUDED INCLUDE Products/Comp Operations Rate Premium Prem. No. Bldg. No. Class Code Exposure Basis Class Description: Premises/Operations Rate Premium Products/Comp Operations Rate Premium Prem. No. Bldg. No. Class Code Exposure Basis Class Description: Premises/Operations Rate Premium Products/Comp Operations Rate Premium CLS-SP-1 L(10-93) ENDORSEMENT A� SCOTTSDALE INSURANCE COMPANY° NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF (12:01 A.M.STANDARD TIME) NAMED INSURED AGENT NO. POLICY NUMBER CPS8284857 09/12/2025 MATCH POINT TENNIS ACADEMY, LLC 04027 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to this endorsement, SECTION II—WHO IS a. All work, including materials, parts or equip- AN INSURED is amended to include as an additional in- ment furnished in connection with such work, sured any person or organization whom you are required to on the project (other than service, mainte- add as an additional insured on this policy under a written nance or repairs) to be performed by or on contract, written agreement or written permit which must be: behalf of the additional insured(s) at the loca- a. Currently in effect or becoming effective during tion of the covered operations has been com- pleted; or the term of the policy; and b. That portion of"your work" out of which the in- b. Executed prior to the "bodily injury," "property jury or damage arises has been put to its in- damage," or"personal and advertising injury." tended use by any person or organization The insurance provided to these additional insureds is lim- other than another contractor or subcontrac- ited as follows: for engaged in performing operations for a 1. That person or organization is an additional insured principal as a part of the same project. only with respect to liability for "bodily injury," 3. The limits of insurance applicable to the additional "property damage" or "personal and advertising insured are those specified in the written contract, injury" caused, in whole or in part, by: written agreement or written permit or in the Decla- rations for this policy, whichever is less. These lim- a. Your acts or omissions; or its of insurance are inclusive of, and not in addition b. The acts or omissions of those acting on your to, the Limits of Insurance shown in the Declara- behalf. tions for this policy. A person's or organization's status as an addi- 4. Coverage is not provided for "bodily injury," tional insured under this endorsement ends when "property damage," or "personal and advertising your operations for that additional insured are injury" arising out of the sole negligence of the completed. additional insured. 2. With respect to the insurance afforded to these 5. The insurance provided to the additional insured additional insureds, the following exclusions are does not apply to "bodily injury," "property damage," added to item 2. Exclusions of SECTION I— or "personal and advertising injury" arising out of COVERAGES: an architect's, engineer's or surveyor's rendering of or failure to render any professional services This insurance does not apply to "bodily injury," including: "property damage" or "personal and advertising injury" occurring after: Includes copyrighted material of ISO Properties, Inc.,with its permission. Copyright, ISO Properties, Inc.,2004 GLS-150s(7-06) Page 1 of 2 a. The preparing, approving or failing to prepare written contract specifically requires that this insur- or approve maps, shop drawings, opinions, re- ance be primary. ports, surveys, field orders, change orders or drawings and specifications; and When this insurance is excess, we will have no du- ty under SECTION I—COVERAGES to defend the b. Supervisory, inspection, architectural or engi- additional insured against any "suit" if any other in- neering activities. surer has a duty to defend the additional insured against that "suit." If no other insurer defends, we 6. Any coverage provided hereunder will be excess will undertake to do so, but we will be entitled to the over any other valid and collectible insurance avail- additional insured's rights against all those other able to the additional insured whether primary, ex- insurers. cess, contingent or on any other basis unless a AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties, Inc.,with its permission. Copyright, ISO Properties, Inc.,2004 GLS-150s(7-06) Page 2 of 2