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<br /> ACC>RaP CERTIFICATE OF LIABILITY INSURANCE DA01I/1212026 '
<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 /> Bene-Marc Athletic Insurance Agency#OE67789 PHONE (800)247-1734 FAX No
<br /> 6301 Southwest Bouievard,Suite 101 E-MAIL contact@bene-marc.com
<br /> ADDRESS;
<br /> Fort Worth,Texas 76132 INSURERS AFFORDING COVERAGE NAIL#
<br /> INSURER A: 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 INSURER C:
<br /> South El Monte,CA 91733 INSURERD:
<br /> SCMAF Member: Pat Hurley-Basic Guitar INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 9066-57159 REVISION NUMBER: REVISED 02/0512026
<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 ADDTYPEOFINSURANCE INSD WVDSUBR POLICY NUMBER MMfDIOf Y YYF Y MMlDD[YYY LTR Y LIMITS
<br /> X COMMERCIALGENERAL.LIABILITY EACH OCCURRENCE $ 1,000,00().00
<br /> 18LB8383 01101/2026 01/01/2027 DAMAGE TO RENTED
<br /> CLAIMS-MADE FRIOCCUR PREMISES Eaoccurrence $ _ 100,000.00
<br /> MED EXP(Any one person) $ 5,000.00
<br /> A X X Abuse& Molestation PERSONAL&ADV INJURY s 1,000,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00
<br /> POLICY JEC PROT F] LOC 1,000,000OOC./2,000,000Agg. PRODUCTS-COMPIOPAGG S 1,000,000.00
<br /> OTHER: Participant Liability $ 1,000,000.00
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
<br /> IF.
<br /> accident
<br /> ANY AUTO BODILY INJURY{Per person) 5
<br /> OWNED SCHEDULED BODILY INJURY(Paracc§dent) 5
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE 5
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> 5
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $
<br /> DED RETENTIONS $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y!N STATUTE ER
<br /> ANYPROPRIETORIPARTNER!EXECUTIVE ❑ NIA
<br /> F,L.EACH ACCIDENT $
<br /> OFFICERfM EMBER EXCLU DED7
<br /> IMandatory in NHI E.L.01SFASE-FA EMPLOYEE 5
<br /> ff yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B Participant Accident Medical SRPO-50256-243 01101/2026 01/01/2027 Deductible: $0.00 Limit: $5,000.00
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS 7 VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached it more space is required)
<br /> This policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder per form CG 20 26 07 04, The General Liability policy contains Primary and
<br /> Non Contributory 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
<br /> 24 04 05 09.Gity 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: Pat Hurley-Basic Guitar APPROVED
<br /> Coverage is limited to the following activity dates: 0 1 1 1 212 6-0 313 012 6
<br /> By Tu Tran Nguyen at 2:37 pm,Feb 09, 21726
<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
<br /> Santa Ana,CA 92701 1/vAl+ I{,4�1 r�t,J�✓, F`�'}]J,,
<br /> Alisa Lynn Hall
<br /> iD 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and loge are registered marks of ACORD
<br />
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