CAZALES, RODOLFO DBA TOYAMA KARATE-DO ORGANIZATION

Home Browse Search

Policy Number: Date Entered: 02/07/2018 � i% O CERTIFICATE OF LIABILITY INSURANCE DATE I/901YYYY) 2/7/2015 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(les) 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 endorsemen s . PRODUCER Reindeer Insurance Services 14037 Pioneer Blvd Norwalk CA 90650 N-2018-125 CONTACT NAME: .- PHONE . (562) 406-8838 FAX Net , (562) 406-8837 pooRless c sr@ Cruckbypass . com� INSURERS AFFORDING COVERAGE NAIC9 INSURERA:United States Fire Insurance Company AH-GA2692-004 INSURED Toyama Karate DO INSURER 8: _ INSURER C_: MED EXP (Any one Orson S5,000 Rodolfo CaSaleZ 1030 Moore Street INSURER D; Santa Ana, CA 92704 INSURER E; INSURER F: PERSONAL&ADV INJURY $1,000,000 CUVENAGCN GER'I'IFICATF NUTARFR• owmauirw Mlnm Co• 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 ADD Jum S POLICY NUMBER POLICY EFF MMIDOry V PO CY EXP M ID V LIMITS A COMMERCIAL GENERAL LIABILITY2,000,000 CLAIMS -MADE X OCCUR AH-GA2692-004 01/01/2018-01/01/2019.' - EACH OCCURRENCE $ PREASES Es occunenca $100,000 MED EXP (Any one Orson S5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- LOC GENERAL AGGR EGATE $4,000,000 PRODUCTS - COMPIOPAGG $ $ OTHER: AUTOMOBILE LIABILITY --.Ea..amnt ' COMILNEDSINGL LIMIT $ ANY AUTO _.- BODILY INJURY (Par person) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY _ AUTOS ONLY "-'' {� v,� 6'e r� P.rM S,Jy BODILY INJURY (Per accident) S PROPERTY DAMAGE Par accident)$ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ATE S EXCESS LIAR CLAWS -MADE DEC I I RETENTION $ $ A. WORKERS COMPENSATIONPER ANYPROPRIETORIPARTLIABILITY NEIVEXECUTIVE YIN OFFICERIMEMSER EXCLUDED? (Mandatory in NH),eGr HYes,descnI, under DE SGRIPTION OF OPERATIONS below NIA Y �a} - RCSE.L. �i� AG 1'"� 'r% y� gt,�L1 P Thi- STATUT ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Sahedulo, may be attached it more space la.,wivo ) Karate School Additional Location:2320 N Grand Ave Santa Ana CA 92705 Certificate holder, its officers, agents, and employees are named as Additional Insured in regard to General Liability CITY OF SANTA ANA Att: PRCSA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 CIVIC CENTER PLAZA M-23 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1986 ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92702 AUTHORIZED REPRESENTATIVE i ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced usina Forms Boss Plus software. www.FornrsBoss.com', Imoresslve Publishina 800.208-1977