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DATE(MMIDDIYYYY) ACOR�� CERTIFICATE OF LIABILITY INSURANCE 02/05/2025 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 endorsoment(s). PRODUCER CONTACT NAME: Bene-Marc Athletic Insurance Agency#OE67789 PHONE t.(800)247-1734 (AArc No): 6301 Southwest Boulevard,Suite 101 E-MAIL Contact@bene-mare.com ADDRESS: Fort Worth,Texas 76132 INSURER(S)AFFORDING COVERAGE NAIC A INSURER A: HDI Global Specialty SE AA-1120822 INSURED INSURER B: AXIS Global Accident&Health Insurance Company 37273 Southern California Municipal Athletic Federation(SCMAF) PO Box 3605 INSURER C: South El Monte,CA 91733 INSURER D: SCMAF Member- Santa Ana Lawn Bowling Club-Don Marthens INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 9066-55782 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 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 POLICYNUMBER IMMIDDffYYYI (MMfDDffYYYILIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000.00 16LB7323 (11101/2025 01/01/2026 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 100.000.00 MED EXP(Any one person) S 5,000.00 A X X Abuse&Molestation PERSONAL&ADV INJURY s 1,000,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 5,000,000.00 POLICY El PRO-JECT El LQG 1,000,OOOOcc./2,000,OoOAgg. PRODUCTS-COMPIOPAGG S 1,000,000.00 JEC OTHER: Participant Liability S 1,000,000.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO RODiLY INJURY(Per person) S OWNED F SCHFOLILED BOC]ILY INJURY Per accident AUTOS ONLY AUTOS Y( ) S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE S ❑ED I I RETENTIONS S WORKERS COMPENSATION PER CTH- AND EMPLOYERS Y1N LIABILITY STATUTE ER ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEM DER EXCLUDED? NIA E.L.EACH ACCIDENT S (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Participant Accident Medical SRPO-50256-243 01/0112025 01/01/2026 Deductible: $0.00 Limit: $5,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) This policy includes a blanket additional insured endorsement that provides additional insured status to the certificate hoSdar per form CG 20 26 07 04, The General Liability policy contains Primary and Non Contributory wording per endorsement E 1602AJ-1112.The General Liability policy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attached form CG 24 04 05 09.City of Santa Ana entity,it's officers,officials,agents and it's volunteers are additional insured_ Tu Tra f1 o�yaziay s�9�e by Coverage for SCMAF member approved activities for which a premium is aid and reported to the Company. %77e 9 PP p P Poa�z zon o� SCMAF Member: Santa Ana Lawn Bowling Club-Don Marthens Nguyen ,s:usse-07oo Coverage is limited to the fallowing activity dates: 02/05l2 5-1 213 1/2 5 APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 3:05 pm,Jul02,2025 City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana,Parks,Recreation and Community Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana.CA 92701 (� Alisa Lynn Hail ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD