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AC"RbF CERTIFICATE OF LIABILITY INSURANCE
<br />11i
<br />DA 03/11/2025
<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
<br />CONTACT
<br />NAME:
<br />Bene-Marc Athletic Insurance Agency #OE67789
<br />6301 Southwest Boulevard, Suite 101
<br />Fort Worth, Texas 76132
<br />PNC NEs. (800) 247-1734 ac No
<br />E-MAR contact@bene-marc.com
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAICN
<br />INSURERA: HDI Global Specialty SE
<br />AA-1120822
<br />INSURED
<br />Southern California Municipal Athletic Federation (SCMAF)
<br />INSURER B: AXIS Global Accident & Health Insurance Company
<br />37273
<br />PO Box 3605
<br />INSURER C:
<br />INSURER D:
<br />South El Monte, CA 91733
<br />INSURERS:
<br />SCMAF Member: Holistic Yoga & Health, LLC - Yoga, Meditation, Tai Chi
<br />NSURERF:
<br />COVERAGES CERTIFICATE NUMBER: UUDs-obfuz REVISION NUMBER: Revised 04/09/2025
<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 />LTR
<br />TYPE OFIN$URANCEJUM
<br />ADDL
<br />SUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />IMMIDDIVY)FIF1
<br />POLICY EXP
<br />fINIMIDIVYYYY1LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />OCCUR CLAIMS -MADE
<br />18LB7323
<br />01/01/2025
<br />01/01/2026
<br />EACH OCCURRENCE
<br />$ 1,000,000.00
<br />q REWEo
<br />PREMISES Ea occurrence
<br />$ 100,000.00
<br />MED EXP(Any one person)
<br />$ 5,000.00
<br />PERSONAL &ADV INJURY
<br />S 1,000,000.00
<br />A
<br />X
<br />X
<br />Abuse & Molestation
<br />AGGREGATE LIMIT APPLIES PER:
<br />PODCV ❑ JECT ❑ LOG
<br />GENERAL AGGREGATE
<br />$ 5,000,000.00
<br />GEN'L
<br />1,000,000 Occ./2,000,000 Agg.
<br />PRODUCTS - COMP/GP AGO
<br />$ 1,000,000.00
<br />Participant Liability
<br />$ 1,000,000.00
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />_
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION
<br />$
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LABILITY YIN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBEREXCLUDED9
<br />NIA
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />(Mandatory in NH)
<br />Use. describe under
<br />DESCRIPTION OF OPERATIONS held.
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br />B
<br />Participant Accident Medical
<br />SRPO-50256-243
<br />01/01/2025
<br />01/01/2026
<br />Deductible: $0.00
<br />Limit: $5,000.00
<br />Tu
<br />ran Digi lly gnedb
<br />TU TranN u
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached if more space is required) N U en Date 2025A9J2
<br />9 Y oee,:sa-dro3•
<br />This policy Includes a blanket additional insured endorsement that provides additional insured status to the wnificate holder per form CG 20 26 07 04. The General Liability policy contains Primary and
<br />Non Contributory.arding per endorsement El 602AJ-1 112, The General Liability policy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attachetl form CG
<br />24 04 05 OgG ty of Santa Ana entity, it's officers, officials. agents and its volunteers are additional insured.
<br />Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company.
<br />SCMAF Member: Holistic Yoga & Health, LLC -Yoga, Meditation, Tai Chi APPROVED
<br />Coverage is limited to the following activity dates: 03/05125-05128/25; 06102125-09/30/25: 10101/25-12/31/25 By Tu Train Nguyen at 8:31 am, Apr 17, 2025
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Attention: Parks, Recreation, and Community Services Agency
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza M-23
<br />Santa Ana, CA 92702
<br />A REPRESENTATIVE `. 6
<br />/U'
<br />L
<br />ALisa isa Lynn n Hall
<br />91988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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