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AI D® CERTIFICATE OF LIABILITY INSURANCE o ;71n1 THIS CERTIFICATE E 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 INSURR�,f,r DOE5 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIVED REPRESENTATIVE OR PRODUCER, AND k"FICJE ,, 0 IMPORTANT: Il the balrbee holder is an ADDITIONAL INSURED, the p01AyQes) must be endorsed. If SUBROGATION IS WANED, sI to he terms and cWdklOns of the Polity, C'Q fotchassmey,requireanendonsement Aa181amenton this 0etdcate dos not conIVrdDhlost)b tedl0ceh holder in lieu of such IMoreema�� SIG PNODW@cour Risk Management Services, Inc."` ct NRA ME PNONF fAN (6011 $40-3134 A4 No.16071 274-9130 P.O. BOI 33711 Phoenix A2 550645711 ENTALlnfcetherie eo le.com Asproad INSMMSAFPOFCIXG COERME NAICa Ie9lemI Aa en gpniqov Insurance rn 10717 L 7,000,000 INSURED O.C. Affinity Swim IXSIREq B. Nationwide Life Insurance Co. 66069 XSNRERG Y CPASD9m1 LRB INNRFRo. 5115/1017 (Darcyn Amateur Swimming Assoc Corp) 119 Nest Cliffwcod An INSURERS: PERSONS A WVII Anaheim CA 94501 , 1 OI,$Q INNgERF. �II COVERAGES CERTIFICATE NUMBER: Cert ID 9107 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 REOUIPEMENT, TERM OR CON09ION OF ANY WN7RAC7 OR OTHER DOCUMENT WITH RESPECT TC 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 OFSUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MSR LTR rypEcf lXMlA1NtF III off POLICYMIMEER POLOEFF MU RMICYpP N IM116 rLNERAL IANILTY EACH MURPFNCE L 7,000,000 11DAZT17mr— PREMSESSaxamercel S 100,000 A M COMMEPCIWGEVERSLABILITY CWIMSdWEDI OCCUR Y Y CPASD9m1 LRB 511511011 5115/1017 MED ENP Am ore NI I MALI PERSONS A WVII 1 1,000,000 I Participant Legal GEIERUAGGREGATE I 3,000,000 I Liability Included PRODUCTS COMM AGO 1 31000,000 COIL AGGRI OMIrpPRIES PER, PoUM I KrPPP lW ASOSEIMOLESRA7I0N E 550,000 AmOMOMLE LINE LIW COMMINEO SINTIE LIMIT Eaadaol 1,000,000 PONLYIWINYHeIPmmA S A AVMC y Y CBASO9G11 ITS 5115/1011 5/15/1017 AILMED SCHEDULED ANDS AUTOS BONLYIWMRY PeIauMaT S N mRSCwTos I AUTOS pppROVLi) A6 0 FOR N�EumCw GE s UNSRELIALIAB OCCUR L' RICKOCOSPOCE S EMS LIAB DIAIMSMWE OFD RETENTIONS iJ !� L �q AGOREOATE WoRIRRSCONPENSUON- ANDEMPLO LABINY YIN ANYPROPRETORPWMEGEXEOMNE� CROETPMEMBEREGOEm NIA AevelMnl Lily RGy WC9fA[LL 07M ELEACHACCIDENT S ELDBEf1: FaMPLME S (Mmtleory F NX) XNy�Wr AV DESC9IFON OF OPER4TIONS Now ELDI9EAREPSILYLIMr $ B ME Medical/Dental 0017637iS 511511011 511515015 Maximum Limit $ 55,000 AIDED Maximum Limit $ 5,000 DEMAPTION OF OPERATIONS ILOG➢ONSIVEHICIES Abu AM 101, Adflf FmM SoNII1 mm Unce Is II Verification of General Liability coverage for Swimming Lesions, excess MedicallDutal coverage provided for the Insured's Puticipents only, 30 day cancellation per policy provisions. Rbc City of But& An, its officers, agents ad employees us included as Additional Insured on General Liability, but only as respects to the Named Insured's operations. City of Santa Ana, Perks, Recreation And Commority Services Agency Art Dome Schultze 1825 N Civic Center Sense Ane CA 93701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROM ISIONS ®19883010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo us registered marks 0ACORD Page 1 of 1