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CEKI IFICATE OF LIABILITY INSURANCETHIS <br />pA'E(MMODY rY, <br />20612019 <br />CERTIFICATE IS ISSUED AS A MATTER OF7RFORMATION 0 <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ER. THIS <br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE <br />OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If e ceflifficate holder Is an ADDITIONAL INSURED, t e pa c s Must rave ADDITIONAL INSURED Provisions or be endorse <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, Certain policies may require an endorsement. A statement on this <br />certificate does not corder rl hts to the certificate holder In lieu of such endorsemen s . <br />PRODUCER <br />K&K Insurance Group, Inc. <br />1712 Magnavox Way <br />CONTACT . Mass Merchandising Underwriting <br />,yc No -L 1.800.508.4656 No. 1-260-459-5590 <br />ADDRE68: In(o@ffnessinsurance*k.Com <br />Fort Wayne IN 46804 <br />C TOM ERID, <br />INSURER(S) AFFORDING COVERAGE <br />NAICe <br />INSURED <br />Denise Rabies <br />1664 W. Cindy Ln Apt #6 <br />Anaheim, CA 92802 <br />INSURER A: Nationwide Mutual Insurance Company <br />23787 <br />INSURER s: <br />INsuRERc: <br />A Member of the Sports, Leisure & Entertainment RPG <br />INSURER D: <br />INSURER E: <br />NSURERF: <br />_-.-...._.-. _ .._...__... ....—,.r, v MCTIOIVIN NUMCCR: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS. <br />LTR <br />A <br />TYPE OF INSURANCE <br />X CoMMERWALGENERALLIANUTY <br />WES& Fx-1 OccuR <br />EIBD <br />X <br />WVD <br />POLICY NUMBER <br />88RP000DO007214800 <br />01101Y2020 <br />1201 AM EDT <br />MNCn'YYY <br />01/042021 <br />12:01 AM <br />LIMITS <br />EACH OCCURRENCE <br />$1.000,ODO <br />TgXUM, pu <br />PREMISES E e <br />$1,000,000 <br />MEDEXP(Anyonepww) <br />$b000 <br />PERSONAL S ADV WI Y <br />$1,000,000 <br />OENERALAGOREGATE <br />$5.000,ODO <br />GENL AGGREGATE UMU APPLIES PER <br />PRO <br />JECT ❑LOC O <br />OTHER: <br />OTHER <br />PRODUCTS -COMPIOP AGO <br />$1,000,000 <br />PROFESSIONAL UABILMY <br />$1.000,000 <br />LEGAL LIAR TO PARTICIPANTS <br />$1.000.000 <br />AUTOMOBRE <br />LIABILITY <br />PINY AUTO <br />OWNED AUTOS r7 SCHEDULED <br />ONLY AUTOS <br />HIRED NON OWNEp <br />AUTOS ONLY d AUTOS ONLY <br />NOT PROVIDED WNLE N HAWMI <br />Ma apident <br />BODILYNAAtY(Perpp ) <br />BODILY INURY(Per scddm ) <br />MAGE <br />Pw ecddenl <br />LMB OCCUR <br />EACH OCCURRENCE <br />IlMeR9.lA <br />EXCESS UAB CW16r,"ADE <br />AGGREGATE <br />DEDEl RETENTION <br />EMPLOYE COMPENSATION AUTO <br />91PLOYF%•UgNLRY <br />N/A <br />STAME Li OTHER <br />ANY PROPRETORIPAITfNER/ YIN <br />EXECUTIVE OFFICERAIEMBER <br />BX LUOED'! (Need "w N" <br />EL FPCHACCOPNT <br />EL CISEASE-EAEMRQYEE <br />Yrm dm.ibe uVler DESCRIPTION <br />EL DISEASE -POLICY LrArr <br />OFOPERATIONSb*w <br />MEDICAL PAYMENTS FOR PARTICIPANTS <br />PRWARY MEDICAL <br />EXCESS MEDICAL <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES LACORD let, Add al RMIMAe Sch k,mryWetladladrmore epcee is Mused) <br />Noncerthled Instructor of. Acrobaticlpartner yoga, ZUMBA <br />The Certificate holder is added as an addlfional Insured, but Only for (lability Caused, in Whole or In part, by the acts or orrdsslonS of the named Insured. <br />REVIEWED & APPROVED <br />T DIVISION <br />20 Civic Center Plaza <br />Santa Arm, CA 92702 <br />(OwnedLessor of Premises) <br />POLICY <br />Coverage is orYy extended to U.S. Wtl N"Sss'. K" r W—' - <br />NOTICE TO TEXAS INSUREDS: The Insurer for the purdNadrg group may not be sublect 10 all the Insurance laws and mgulations of the State of Texas <br />IN <br />ACORD 25 (2016103) m 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name Ntd logo ere registered marks of ACORD <br />