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111 <br /> � DATE(MM/DD/YYYY) <br /> ,4cvo CERTIFICATE OF LIABILITY INSURANCE 01/12/2026 <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 CONTACT <br /> NAME: <br /> N (800)247-1734 <br /> Bene-Marc Athletic Insurance Agency#OE67789 A/CNo Ext: FAX NO): <br /> 6301 Southwest Boulevard,Suite 101 E-MAIL contact@bene-marc.com <br /> Fort Worth,Texas 76132 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA: HDI Global Specialty SE AA-1120822 <br /> INSURED INSURER B: AXIS Global Accident&Health Insurance Company 37273 <br /> Southern California Municipal Athletic Federation(SCMAF) <br /> PO Box 3605 INSURERC: <br /> South El Monte,CA 91733 INSURER D: <br /> SCMAF Member: Roxanne Aguilar-Sewing INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 9066-57159 REVISION NUMBER: REVISED 02/05/2026 <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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 <br /> 18LB8383 01/01/2026 01/01/2027 DAMAGE TO RENTED <br /> CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ 100,000.00 <br /> MED EXP(Any one person) $ 5,000.00 <br /> A X X Abuse&Molestation PERSONAL&ADV INJURY $ 1,000,000.00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00 <br /> X POLICY❑ JECT PRO ❑ LOC 1,000,000 OCC./2,000,000 Agg. PRODUCTS-COMP/OP AGG $ 1,000,000.00 <br /> OTHER: Participant Liability $ 1,000,000.00 <br /> AUTOMOBILE LIABILITY C Ea OMBINEDSINGLELIMITid $ <br /> accent <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA <br /> E.L.EACH ACCIDENT $ <br /> E OFFICER/MMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> B Participant Accident Medical SRPO-50256-243 01/01/2026 01/01/2027 Deductible: $0.00 Limit: $5,000.00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> This policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder perform CG 20 26 07 04. The General Liability policy contains Primary and <br /> Non Contributory wording 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 attached form CG <br /> 24 04 05 09.City of Santa Ana entity,it's officers,officials,agents and it's 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: Roxanne Aguilar-Sewing APPROVED <br /> Coverage is limited to the following activity dates: 01/22/26-04/25/26 By Tu Tran Nguyen at 3:55 pm,Feb 11,2026 <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana Risk Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza <br /> AUTHORIZED REPRESENTATIVE a n � <br /> Santa Ana,CA 92701 �ll}�Yn�'.UnJS <br /> Alisa Lynn Hall <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />