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A� 0 DATE(MMIDOfYYYYI `� CERTIFICATE OF LIABILITY INSURANCE 07/2212025 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: PHOEAX Bene-Marc Athletic Insurance Agency#OE67789 WCN o (800)247 1734 A/C No): 6301 Southwest Boulevard,Suite 101 E-MAIL contact@bene-marc.com ADDRESS: Fort Worth,Texas 76132 INSURER(S)AFFORDING COVERAGE NAICiI INSURER A: IHDI Global Specialty SE AA-1120822 INSURED INSURER B: AXIS Global Accident&Health Insurance Company 37273 Southern California Municipal Athletic Federation(SCMAF) PCs Box 3605 INSURER C South El Monte,CA 91733 INSURER D SCMAF Member Clara Junge-Salsa& Bachata Dance 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 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 A➢OL.SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMI➢DNYYY MMIDOfiYYY LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000.001 18LB7323 01101/2025 01101/2026 DAMAGE TO RENTED CLAIMS-MADE O OCCUR PREMISES Ea occurrence $ 100,000.00 MED EXP{Any one person} $ 5,000.00 A X X PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00 JECT POLICY PRO LOC PRODUCTS-COMPIOPAGGS 1,000,000.00 OTHER: Participant Liability $ 1,000,000.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acciden9 5 UMBRELLA LIAB OCCUR EACHOCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETCRIPARTNERIEXECUTIVE ❑ EL EACH ACCIDENT 5 OFFICEWMEMSER EXCLUDED? NIA (Mandatory in NH) E-L.DISEASE-EA EMPLOYEE 5 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Participant Accident Medical SRPO-50256-243 01/01/2025 01101/2026 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 addilicnai insured status to the certificate holder per form CG 20 26 07 04 The General Liability policy contains Primary and Non Contributory wording per endorsement E 1 602AJ-1 112.The General Liability pelicy 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,its City Council,officers,officials employees,agents and volunteers are named additional insured. Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company. SCMAF Member: TU Tran Digitally Signed by Clara Junge-Salsa&Bachata Dance Classes rurran Nguyen Date:2025.09.11 Coverage is limited to the following activity dates: 10101125-12131125 Nguyen 12:52:37-0�'00' APPROVED CERTIFICATE HOLDER CANCELLATION ByTu Tran Nguyen at 12:52pm,Aug 11,2025 City of Santa Ana,its City Council,officers,officials,employees, agents,and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE volunteers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza M-23 AUTHORIZED n HallSEN7ATIVE ( A+i4A/ R ya Santa Ana,CA 92702 Alisa Lynn Hall O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD