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A DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 1
<br /> 02/10/2025
<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 CONTACT
<br /> NAME:
<br /> Bene-Marc Athletic Insurance Agency#OE67789 HONE
<br /> /C No,
<br /> o E:t: (800)247-1734 FAX No):
<br /> 6301 Southwest Boulevard,Suite 101 E-MAIL contact@bene-marc.com
<br /> ADDRESS:
<br /> Fort Worth,Texas 76132 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: HDI Global Specialty SE AA-1120822
<br /> INSURED INSURERB: AXIS Global Accident&Health Insurance Company 37273
<br /> Southern California Municipal Athletic Federation(SCMAF)
<br /> PO Box 3605 INSURER C
<br /> South El Monte,CA 91733 INSURER D
<br /> SCMAF Member: Roxanne Aguilar-Sewing Classes INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 9066-55782 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 SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00
<br /> 18LB7323 01/01/2025 01/01/2026 DAMAGE To RENTED 100,000.00
<br /> CLAIMS-MADE � OCCUR PREMISES RENTED.
<br /> $
<br /> MED EXP(Any one person) $ 5,000.00
<br /> A X X Abuse& Molestation PERSONAL&ADV INJURY $ 1,000,000.00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00
<br /> X POLICY JECT PRO LOC 1,000,000 OCC./2,000,000 Agg. PRODUCTS-COMP/OPAGG $ 1,000,000.00
<br /> OTHER: Participant Liability $ 1,000,000.00
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> ❑
<br /> OFFICER/MEMBER EXCLUDED? N I A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B Participant Accident Medical SRPO-50256-243 01/01/2025 01/01/2026 Deductible: $0.00 Limit: $5,000.00
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<br /> T„T,,,,Npy,
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) guyen t.4,,,-.
<br /> This policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder per form CG 20 26 07 04. The General Liability policy contains Primary and
<br /> Non Contributory wording per endorsement El602AJ-1112.The General Liability policy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attached form CG
<br /> 24 04 05 09.City of Santa Ana entity,it's officers,officials,agents and it's volunteers are additional insured.
<br /> Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company. APPROVED
<br /> SCMAF Member: Roxanne Aguilar-Sewing Classes By Tu Tran Nguyen at 9:39 am,Feb 11, 2025
<br /> Coverage is limited to the following activity dates: 02/10/25-02/22/25;03/01/25-03/29/25;04/05/25-04/26/25
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Santa Ana, Parks, Recreation and Community Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> AUTHORIZED Lynn
<br /> n HallSENTATIVE a � 1
<br /> Santa Ana,CA 92701 �1hi�rf�t^AIX1)(nN)'
<br /> Alisa Lynn Hall
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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