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A�Rom® CERTIFICATE OF LIABILITY INSURANCE DA02/110/202"5 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: Bene-Marc Athletic Insurance Agency#OE67789 WC PHONE t, (800)247 1734 we No: 6301 Southwest Boulevard.Suite 101 EMAIL contact@bene-marc.com ADDRESS: Fort Worth,Texas 76132 INSURER 5 AFFORDING COVERAGE NAIC0 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: Roxanne Aguilar-Sewing Classes 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 1S 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 JSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACHOGCURRENCE s 1,000,000.00 18LB7323 01/0112025 01/01/2026 DAMAGE TO RENTED CLAIMS-MADE ®OCCUR PREMISES Ea occurrence $ 100,000.00 MED EXP(Any one person) $ 5,000.00 A X Abuse&Molestation PERSONAL&ADV INJURY $ 1,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00 POLICY❑PRJECT o- LOC 1,000,000 Occ.12,000,000 Agg. PRODUCTS-COMP/OP AGG $ 1,000,000.00 OTHER: Participant Liability s 1,000,000.00 AUTOMOBILE LIABILITY C0 "' DSINGLELIMIT 5 Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE 5 AUTOS ONLY AUTOS ONLY Per accident 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DIED RETENTIONS 5 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y f N STATUTE ER ANYPROPR IETORIPARTN ER.EXECUTIVE OFFICER7HI EMBER EXCLUDED? NIA. E,L,EACHACCIDENT 5 {Mandatory in NHI E.L.,DISEASE-EA EMPLOYEE 5 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S B Participant Accident Medical SRPO-50256-243 01101/2025 01/01/2026 Deductible $0.00 Limit: $5,000.00 Tu Tran T.T; N9,,„'r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) g as'^o'26 oe' This policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder per farm CG 20 26 07 04. The General Liability policy contains Primary and Non Coniributary wording per endorsement E1602AJ-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.Cily of Santa Ana entity,it's officers..officials,agents and irs volunteers are additional insured. Coverage for SCMAF member approved activities for which a premium is paid and reported t0 the Company. APPROVED SCMAF Member: Roxanne Aguilar-Sewing Classes By Tu Tran Nguyen at 9:39 am,Feb 11,2025 Coverage is limited to the following activity dates; 02/10/25-02/22/25;03101125-03/29/25:0410 512 5-04/2 6/2 5 CERTIFICATE HOLDER CANCELLATION 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 Ball O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD