ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
PHONE FAX
(A/C, No, Ext): (A/C, No):
E-MAIL
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS (MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO- POLICY LOC JECT PRODUCTS - COMP/OP AGG
OTHER: $
COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident) $
$
OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $
PER OTHSTATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
1/28/2026
License # 0H18131
(818) 933-2700 (818) 933-2701
13064
Ferandell Tennis Courts, Inc.
Paul Ferandell
3216 Grey Hawk Ct.
Carlsbad, CA 92010
11770
17370
27847
19682
A 1,000,000
X X CSC0001374 5/26/2025 5/26/2026 100,000
10,000
1,000,000
2,000,000
2,000,000
Deductible 2,500
B 1,000,000
X X 998465041 12/5/2025 6/5/2026
C 2,000,000
AN1349551 5/26/2025 5/26/2026 2,000,000
D
X WVE505556205 5/26/2025 5/26/2026 1,000,000
1,000,000
1,000,000
E Rental Equipment 72MSHC1846 6/26/2025 Deductible 1,000 E Rental Equipment 72MSHC1846 6/26/2025 6/26/2026 Equipment 66,500 The City of Redondo Beach, it's officers, elected and appointed officials, employees and volunteers are included as Additional Insureds in the event liability arises
City of Redondo Beach
415 Diamond Street
Redondo Beach, CA 90277
FERATEN-01 JPFAFFENBERGER
Momentous Insurance Brokerage, A Marsh & McLennan Agency LLC Company
5990 Sepulveda Blvd., #550
Van Nuys, CA 91411
United National Insurance Company
United Financial Casualty Company
Nautilus Insurance Company
Insurance Company of the West
Hartford Fire Insurance Company
X
6/26/2026
X
X
X
X
X
X
X X
PROGRESSIVE
PO BOX 94739
CLEVELAND, OH 44101
WŽůŝĐLJ ,ŽůĚĞƌ:
:ĂLJ͛Ɛ WŝnjnjĂ
123 Main Street
Highland Heights, Ohio 44143
The attached endorsements listed below applies to policy number: 012345678Ͳ0 Form 2366 (02/11) Blanket Additional Insured Endorsement Form 2367 (06/10) Blanket Waiver of Subrogation Endorsement Endorsement effective: dŽĚĂLJ͛Ɛ ĚĂƚĞ
Endorsements listed above are effective until policy cancellation date.
Ferandell Tennis Courts, Inc.
3216 Grey Hawk Ct
Carlsbad, CA 92010
998465041
June 5, 2025
Form 2366 (02/11)
Blanket Additional Insured Endorsement
This endorsement modifies insurance provided by the Commercial Auto Policy, Motor Truck Cargo Legal Liability Coverage Endorsement, and/or Commercial General Liability Coverage Endorsement, as appears on the declarations page. All terms and conditions of the policy apply unless modified by this endorsement.
If you pay the fee for this Blanket Additional Insured Endorsement, we agree with you that any person or organization with whom you have executed a written agreement prior to any loss is added as an additional insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to such additional insured only as a person or organization liable for your operations and then only to the extent of that liability. This endorsement does not apply to acts, omissions, products, work, or operations of the additional insured.
ZĞŐĂƌĚůĞƐƐ ŽĨ ƚŚĞ ƉƌŽǀŝƐŝŽŶƐ ŽĨ ƉĂƌĂŐƌĂƉŚ Ă͘ ĂŶĚ ď͘ ŽĨ ƚŚĞ ͞KƚŚĞƌ /ŶƐƵƌĂŶĐĞ͟ ĐůĂƵƐĞ ŽĨ ƚŚŝƐ ƉŽůŝĐLJ͕ ŝĨ ƚŚĞ person or organization with whom you have executed a written agreement has other insurance under which it is the first named insured and that insurance also applies, then this insurance is primary to and nonͲcontributory with that other insurance when the written contract or agreement between you and that person or organization, signed and executed by you before the bodily injury or property damage occurs and in effect during the policy period, requires this insurance to be primary and nonͲ contributory.
In no way does this endorsement waive ƚŚĞ ͞KƚŚĞƌ /ŶƐƵƌĂŶĐĞ͟ ĐůĂƵƐĞ ŽĨ ƚŚĞ ƉŽůŝĐLJ͕ ŶŽƌ ŵĂŬĞ ƚŚŝƐ ƉŽůŝĐLJ primary to third parties hired by the insured to perform work for the insured or on the ŝŶƐƵƌĞĚ͛Ɛ behalf.
ALL OTHER TERMS, LIMITS, AND PROVISIONS OF THE POLICY REMAIN UNCHANGED. 0B&/
Form 2367 (06/10)
Blanket Waiver of Subrogation Endorsement
This endorsement modifies insurance provided by the Commercial Auto Policy, Motor Truck Cargo Legal Liability Coverage Endorsement, and/or Commercial General Liability Coverage Endorsement, as appears on the declarations page. All terms and conditions of the policy apply unless modified by this endorsement.
If you pay the fee for this Blanket Waiver of Subrogation Endorsement, we agree to waive any and all subrogation claims against any person or organization with whom a written waiver agreement has been executed by the named insured, as required by written contract, prior to the occurrence of any loss.
ALL OTHER TERMS, LIMITS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED. 0B&/