CAZALES, RODOLFO DBA TOYAMA KARATE-DO ORGANIZATION

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® Policy Number: Date Entered: 01/02/2019 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/2/2019 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 Reindeer Insurance Services CONTACT NAME, 14037 Pioneer Blvd Norwalk CA 90650 PHONE .(562)406-8838 FaArc Me:(562) 406-8837 ADDRESS; car@truckbypass. com .— INSURERS AFFDRDING COVERA-E NAICN _. WsURED Toyama Karate DO INSURERA:United States Fire Insurance conglany Rodolfo C8Lalex N!ao{r_ 1030 Moore Street P WSURER e: __ INSURERC: - -- INSURER D: — Santa Ana, CA 92704 INSURER 9: $1,000,000 INSURER F : - COVERAGES reoT¢Irwrrv. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE KCYIWUN NUMUGR: INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED WITH RESPECT TO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, INSR AD DL SUER EFF ANDY EtP L TYPE OF NNSURMICE POLICY NUMBER MPMNDY A COMMERCUM-GENE1 A 11ASIUTY OMn3 EACH OCCURRENCE $1,000,000 CtAIMS#MOE Fx OCCUR USP262607 ;01/01/2019 01/01/2020 A D PRE ISE. Eatlaurrmm S 300, 000 MED EXP(ArN 0.lanwn) $5,000 PERSONAL INJURY 31.000,000 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY E] PRO- O - F GENERALAGGREGATE $2,000,000 LOC PRODUCTS-COMPIOPAGG $2,000,000 OTHER E AUTOMOBILE LIABILITY COMBINED IN ELI ANYAUTO Eaa ibni)__ $ BODILY INJURY(Pwpemon) $ OWNED SCHEDULED BODILY INJURY (Par ardtlant) $ AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE E E UMBRELLA UAe OCCUR a y ,�\ EACH OCCURRENCE $ EXCESS UAe CLAIM"'OE V V /// AGGREGATE t PER OTH- $ DEO RETENTION $ WORKERS COMPENSATION ANDEMPLOYERSLIABl1TY - YIN MY OFFICEIUMEMBER EXCLUDED? �ECUi1VE ❑,NIA '(�- v� ,! STA ER El, EACH ACCIDENT $ (Mandaory In NH) �- E.L. DISEASE - EA EMPLOYEE $ ttyyea.tlescribeumler DESCRIPTpN OF OPERATIONS bebw \ E.L. DISEASE -POLICY LIMIT $ Q� DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, ADEIHOn.l Remarks ScOetlule, may a aaacnetl I rtgre aWce IN,pulmtl) Karate School 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 CFRTIFireiF U MOD CITY OF SANTA ANA Att:PRCSA 20 CIVIC CENTER PLAZA M-23 PO BOX 1988 SANTA ANA CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' V ©1988-2015 „o -. w. u „n,,,e art" tug0 are reglsrereO marKS DT ACORD Produced using Forms Boss Plus software. w .FormsBoss.com: Imoressive Publishina 800.208-1977 reserved.