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AC V CERTIFICATE OF LIABILITY INSURANCE oarE(MMIDDmrY) Imo" 07/22/2024 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: American Specialty Insurance&Risk Services, Inc. PHONE FAX C N A!C No): dba A.S.I.R.S.I.Insurance Agency(CA License##OE72661) E-MAIL ADDREss: 7609 W.Jefferson Blvd.,Suite 100 INSURER(S)AFFORDING COVERAGE NAIC if Fort Wayne IN 46804 INSURERA: Arch Insurance Company 11150 INSURED INSURER B National Association of Sports Officials(NASD) INSURER C 2017 Lathrop Avenue INSURER D INSURER E Racine WI 53405 INSURER F COVERAGES CERTIFICATE NUMBER: 1002262549 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BELN 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. INSR TYPE Of INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDDlYYYY LIMITS _ X COMMERCIALGENERALLIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE "I OCCUR DAMAGE (RENTED 1,000,000 PREMISESS Ea occurrence � MED EXP(Any one person) S Excluded A Y SBCGL0279607 08/01/2024 08101/2025 PERSONAL BADVINJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S 5,000,000 POLICY 7 PRO- ❑ .fECT LOC PRODUCT$-CDMPIOPAGG $ 5,000,000 X OTHER: OFFICIAL $ AUTOMOBILE LIABILITY COMB 1NED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(PEP accident) $ HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per aceidenl UMBRELLA LAB X OCCUR EACH OCCURRENCE S 5,000,000 A X EXCESS LIAB CLAIMS-MADE SBFXS0044407 08/01/2024 08/01/2025 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y f N STATUTE ER ANYPROPRIETORIPARTNERlEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? NIA {Mandatary in NH) F.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Tu Train Y a ys,9ne 6 Tu 77 NguyenlD t 2025.043E APPROVED 98J 0:43-E7'E1 By Tu Tran!Nguyen at 8:10 am,Apr 30,2025 DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) -Coverage applies to KENNETH NASH,JR,lNASH REFEREE,INC.,24341 FORDVIEW ST,LAKE FOREST,CA 92630. -The Certificate Holder shall be an Additional Insured,but only with respect to the operations of the Named Insured,and subject to the provisions and limitations of Form CG 2026-Additional Insured-Designated Person or Organization,effective August 01,2024. CERTIFICATE HOLDER CANCELLATION City of Santa Ana,Parks, Recreation and Community Services SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 d 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD