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CERTIFICATE OF LIABILITY INSURANCE DATE (MYYYY) 07/17/2022024 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: Bene-Marc Athletic Insurance Agency #OE67789 F ILNE 'IC, No 1r800) $4 -173 Ex • FAX 6301 So est Bo levard Suite 1U1 I M/aIL nt b o � �C RE ' INSURER(S)AFF RDINGCOVERAGE NAIC# FortW h, ex IN URE 7 I al pec ty INSURED I' Sk R B I I C I I pang Southern California MuniciMlOhletic Federation (SCMAF) PO Box 3605 usu� Rc: South EI te, CA 91733 INSI—NSURE • I • • • SCMAFLe er� a e - si ar INSURER F : COV G C I 90F.s-54470 1 • • EVI 02/02/24 REVISED THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTS' BE'.JW HAVE BEEN ISSLAR TME417113FTM NAKXf ABOVIJWTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OF. r'_jNDITION 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 MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 � 18LB6293 01/01/2024 01/01/2025 DAMAGE TO RENTED 100,000.00 CLAIMS -MADE OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 A X X Abuse & Molestation GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00 X POLICY ❑ JECT PRO ❑ LOC 1,000,000 OCC./2,000,000 Agg. PRODUCTS - COMP/OP AGG $ 1,000,000.00 Participant Liability $ 1,000,000.00 OTHER: AUTOMOBILE LIABILITY CEa OMBINEDSINGLELIMITid accent $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Participant Accident Medical SRPO-50256-243 01/01/2024 01/01/2025 Deductible: $0.00 Limit: $5,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) This policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder perform CG 20 26 07 04. The General Liability policy contains Primary and Non Contributory wording per endorsement E1602AJ-1112. The General Liability policy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attached form CG 24 04 05 09.City of Santa Ana entity, its officers, officials, agents and it's volunteers are additional insured. Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company. SCMAF Member: Pat Hurley - Basic Guitar Coverage is limited to the following activity dates: 08/01/24-12/31/24 CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRC 20 Civic Center Plaza % orz„�F RiskManagmumtDMsian AUTHORIZED REPRESENTATIVE z REVIEWED & APPROVED BY: Santa Ana, CA 92701 �� Aceva4 Alisa Lynn Hall i®, ~1 Risk Management Specialist ©1988-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD