INLAND ROUNDBALL OFFICIALS, INC. (2)

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ACOR" CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIODIYYYY) 09/0712025 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: American Specialty Insurance 8,Risk Services,Inc. PHONE FAX A/C No Ezt: AIC Na: dba A.S.I.R.S.I. Insurance Agency(CA License#0E72661) A MAIL - DRESS: 7609 W.Jefferson Blvd.,Suite 100 INSURER(S)AFFORDING COVERAGE NAIL# Fort Wayne IN 46804 INSURERA: Arch Insurance Company 11150 INSURED INSURER B National Association of Sports Officials(NASD) INSURERC: 2017 Lathrop Avenue INSURER D: INSURER E: Racine WI 53405 INSURER F COVERAGES CERTIFICATE NUMBER: 1002394555 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 (NDICATED. 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 SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMiDDNYYY) (MWDDNM LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGET TED CLAIMS-MADE OCCUR PREM[SES Ea REN occurrence $ 1,000,000 MED EXP(Any one person) $ Excluded A Y Y SBCGL0279608 08/01/2025 08/01/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY ECOT- LOG PRODUCTS-CCMPIOP AGG $ 5,000,000 X OTHER: OFFICIAL $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident AUTOS ONLY AUTOS ( I $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE SBFXS0044408 08/01/2025 08/01/2026 AGGREGATE S 9,000,000 DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRI FTORIPARTN ERIEXECUTIV E OFFICERIMEMBEREXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ (Myyandatory in NH) F.L.DISEASE-EA EMPLOYEE $ If s.describe under DESCR PTION OF OPERATIONS below — APPROVED E.L. I..L.DISEASE-POLICY MIT S -7 By Tu Tran Nguyen at 7:34 am,Sep 10,2025 Tran Digitally signed b Tu Tran Nguyen Date:2025.09.10 u en 07:34:42-0TOO' DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) -Coverage applies to JASON LOGAN,3925 SCARLET OAK CT,SAN BERNARDINO,CA 92407. -The Certificate Holder shall be an Additional Insured,but only with respect to the operations of the Named Insured,and subject to the provisions and limitations of Form CG 2026-Additional Insured-Designated Person or Organization,effective September 07,2025. CERTIFICATE HOLDER CANCELLATION City of Santa Ana,Parks, Recreation and Community Services SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE - Santa Ana CA 92701 I 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD