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--1 TUMBINC-01
<br />RCROOK
<br />0A4►(111111
<br />15122025�)
<br />'`,� �� CERTIFICATE OF LIABILITY INSURANCE
<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: 9 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 endomement(s).
<br />PRODUCER
<br />c 9cT Rhonda Crook
<br />Terry L. Green & Associates, Inc.
<br />3100 Five Forks Trickum Road
<br />Suite 101
<br />PHONE FAX
<br />(AIC, No, Exd): (AIC, No);
<br />n ;
<br />Lllburrl, GA 30047
<br />INSURE S AFFORDING COVERAGE
<br />NA1C P
<br />INSURER A: Sirius Point
<br />38776
<br />INSURED
<br />INSURER B :
<br />INSURER C :
<br />Tumble-N-Kids, Inc.
<br />INSURER D :
<br />16802 Lucia Lane
<br />Huntington Beach, CA 92647
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CFRTIFICATF NIIURFR- tawrcrnN MI JIU01=0
<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
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMBS
<br />A
<br />X
<br />COMMERCIAL GENERAL UA13 LM
<br />CLAIMS -MADE ® OCCUR
<br />Abuse/Molestation
<br />X
<br />X
<br />PLH01GL00003941
<br />4/26/2025
<br />4/26/2026
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DA MAGETORENTEDn
<br />$ 300,000
<br />X
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />X
<br />$1M OCC/$2M AGG
<br />PERSONAL BADVINJURY
<br />1,000,000
<br />$
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY PR
<br />T LOC
<br />OTHER: PROFESSIONAL $1 M1$1 M
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$ 1,000,000
<br />X
<br />PARTICIPANT
<br />11000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$
<br />BODILY INJURY Per
<br />$
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY
<br />BODILY INJURY Per accident
<br />$
<br />Per = AMAGE
<br />$
<br />AUTOS ONLY AUTOS ONLD
<br />UMBRELLA L1Ae
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION $
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />FQE I� � E�MNE)' EXCLUDED?
<br />N / A
<br />PER OTH
<br />STA R
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYE
<br />$
<br />(Ma
<br />ifes, describe under
<br />y
<br />E.L. DISEASE - POLICY LIMIT
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Participant Accident
<br />PHSA-BAMH-10248-25
<br />4/26/2025
<br />4/2612026
<br />Excess Coverage
<br />25,000
<br />A
<br />Deductible $500
<br />PHSA-BAMH-10248-25
<br />4/26/2025
<br />4/26/2026
<br />AD&D
<br />10,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more is uired)
<br />Coverage is provided under this policy for sponsored and supervised activities of the named °insured or Whicl a premium has been paid.
<br />Youth Recreational Gymnastics - Mobile Program
<br />The Certificate Holder is an additional insured with respect to the operations of the named insured Digitally sign
<br />Tu Tran
<br />TuTran Ngu
<br />"City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers." Date: 2025.0
<br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. N g u ye n i 2:ss:52 -07
<br />Coverage is Primary and Non -Contributory.
<br />APPROVED
<br />?d by
<br />By Tu Tran Nguyen at 12:31 pm, Apr 16, 2025
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attention: Parks, Recreation, and Community Services Agenc ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, CA 92T01, M-23
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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