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TE ACC CERTIFICATE OF LIABILITY INSURANCE DA02/18/2026 YI 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: _ PHONE (800) 247-1734 FAX Bene-Marc Athletic Insurance Agency#OE67789 AIC Na x1: Arc Not: _ 6301 Southwest Boulevard,Suite 101 E-MAIL contact@gene-marc.corn ADDREss. Fort Worth,Texas 76132 INSURERS AFFORDING COVERAGE NAICff INSURER A: HDI Global Specialty SE AA-1120822 INSURED INSURER B: AXIS Global Accident&Health Insurance Company 37273 Southern California Municipal Athletic Federation(SCMAF) PO Box 3605 INSURER C: South El Monte,CA 91733 INSURER b SCMAF Member: Martin&8aldwin Torres-Karate Do Kiai Martial Arts INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 9066-57159 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. ILTR TYPEOFWSURANCE INSD W D POLICY NUMBER MMlDDft'YYY MMID DIY YYY LIMITS LTR X COMMERCIALGENERALLIABILITY EACH OCCURRENCE S 1,000,000.00 18LB8383 01/01/2026 01/01/2027 DAMAGE TO RENTED 100,000 00 CLAIMS-MADE OCCUR PREMISES(Fa occurrence' $ _ ME EXP(Any one person) $ 5,000.00 A X X Abuse&Molestation PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIM17 APPLIES PER. GENERAL AGGREGATE $ 5,000,000.00 X POLICY PRO- ❑ LOC 1,ODO,000 OCC.I2,OOO,ODO Agg. PRODUCTS-COMPIOPAGG $ 1,000,OOOAO JECT OTHER, Participant Liability S 1,000,000.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident - ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident. UMBRELLA LIAB OCCUR EACHCCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIASILITY YINI STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT i$ OFF ICERIMEMBER EXCLUDED? (Mandatory in NHI E.L.DISEASE-EA EMPLOYEEi S If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Participant Accident Medical SRPO-50256-243 01/01/2026 01/01/2027 Deductible: $0.00 Limit: $5,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) 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 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 24 04 05 09.City of Santa Ana entity.it's officers,officials.,agents and it's volunteers are additional insured. Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company SCMAF Member: Martin&Baldwin Torres-Karate Do Kiai Martial Arts APPROVED Coverage is limited to the following activity dates: 0 211 8/2 6-1 2/31/2 6 By ru Tran Nguyen at 9:19 am,Mar 20,2026 CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZEDREPRESENTATIVE n Santa Ana,CA 92701 \r�JAJI Alisaisa LLynn Hall @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD