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CERTIFICATE OF LIABILITY INSURANCE r ATE(MMIDDNYYY) 051C412025 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 No Ext: A!C No): dba A.S.I.R.S.I. Insurance Agency(CA License#OE72661) E-MAILADDRESS: 7609 W.Jefferson Blvd_Suite 100 INSURER{S)AFFORDING COVERAGE NAIC# Fort Wayne IN 46804 INSURERA: Arch Insurance Company 11150 INSURED INSURER B National Association of Sports Officials(NASO) INSURER C 2011 Lathrop Avenue INSURER D INSURER E Racine WI 53405 INSURER F: COVERAGES CERTIFICATE NUMBER: 1002346737 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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 CERTIRCATS MAY BE fSSUED 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. WSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MM(DDIYYYY MMIDDIYYYY LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE I OCCUR AM I ETORENTED 1,000,000 PRDEMISES Ea occurrence 5 MED EXP(Any one person) S Excluded A Y Y SBCGL0279607 08101/2024 08/01/2025 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 5,000,000 HLOCPOLICY PRO- ❑ PRODUCTS-COMPIOPAGG S 5,000,000 JECT X OTHER: OFFICIAL s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IS Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE s AUTOS ONLY AUTOS ONLY Per aCClderlt S UMBRELLA LIAB X OCCUR EACH OCCURRENCES 5,000,000 A x EXCESS LIAB CLAIMS-MADE SBFXS0044407 08/0112024 08/0112025 AGGREGATE S 5,000,000 DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE F7 E_L,EACH ACCIDENT S OFFiCER1MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS beVow E.L.DISEASE-POLICY LIMIT S APPROVED By Tu Tran Nguyen at 12:08 pm,Jul 07, 2025 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Coverage applies to JASON LOGAN,3925 SCARLET OAK CT,SAN BERNARDINO,CA 92401. Tu Tran Digaally signedby Tu Tran Nguyen Nguyen] 2025.07.07 Nguyen 4 2:0820-07'00' 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 Farm CG 2026-Additional Insured-Designated Person or Organization,effective May 04,2025. 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. Parks,Recreation,and Community Services,M-23 AUTHORIZED REPRESENTATIVE 20 Civic center Plaza Santa Ana CA 92701 c0 1 988-201 5 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD