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TE-KENJUTSU-KAN KARATE-DO (2)
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TE-KENJUTSU-KAN KARATE-DO (2)
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Last modified
10/23/2020 8:46:50 AM
Creation date
10/23/2020 8:45:19 AM
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Contracts
Company Name
TE-KENJUTSU-KAN KARATE-DO
Contract #
N-2020-171
Agency
Parks, Recreation, & Community Services
Expiration Date
10/9/2021
Insurance Exp Date
8/24/2021
Destruction Year
2026
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DATE <br />aco d CERTIFICATE OF LIABILITY INSURANCE <br />PRODUCER <br />Maguire Insurance Agenry, Inc. MI <br />1 Bala PI2 Ste 100 <br />Bala Cynwyd, PA 19DM-1401 <br />610.612.T9D0 <br />INSURED <br />peter mangosing <br />118 w. Steve. ay <br />Santa ana, CA 92707- <br />COVERAGES <br />THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURER <br />INSURER D: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />ADD-L <br />INSRD <br />TYPE OF INSURANCE <br />POLICYNUMBER <br />POLICY EFFECTIVE <br />DATE (MM/DD/YYYY) <br />POLICYEXPIRATION <br />DATEIMM/OD/YYYVI <br />EMITS <br />A <br />X <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMSMADE ❑X OCCUR <br />X PROFESSIONAL LIABILITY <br />GENT AGGREGATE LIM O APPLIES PER: <br />X POLICY F7 PROJECT lOC <br />PHPK154150"M <br />08124120M <br />08/24/2021 <br />EACH OCCURENCE <br />$1,000,000 <br />PREMISES Ezocaurrence <br />$100,W0 <br />MEDEXP(Anyanepermm) <br />$2Suo <br />PERSONAL &REV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$3,000,000 <br />PRODUCTS—COMP/OPAGG <br />$3,000,000 <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED ADIOS <br />HIREDAUT05 <br />NON -OWNED AUTOS <br />COMBINED SINGLE LIMIT <br />(EAacddent) <br />BODILY INJURY <br />(Per person) <br />BODILY INJURY <br />(Per accident) <br />PROPERIYDAMAGE <br />(Peraccldent) <br />GARAGE LIABILITY <br />ANYAUTO <br />AUTO ONLY —EA ACCIDENT <br />OTHER THAN CA ACC <br />AUTO ONLY: <br />AGE <br />EXCESS / UMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />DEDUCTIBLE <br />RETENTION <br />EAQ{ OCCURENCE <br />AGGREGATE <br />EMPLOYERS' LIABILITY V <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandate, In NHI <br />Ifyes,descfibeunder <br />SPECIAL PROVISIONS below <br />IH <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE —EA AMPLOYEE <br />E.L. DISEASE —POLICY LIMO <br />EITHER <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BYENDORSfMENT /SPECIAL PROVISIONS <br />II is understood and agreed Nat the following entity is added as an additional iemred but only with respects) to the ope,aeons Of the named Insured eecept that IiabllRy resulting from the additional imured'e sole <br />negligence. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />20 CiVic Center Fir <br />Santa Ana, CA 92701- <br />THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE <br />CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 50 SHALL IMPOSE NO OBLIGATION OR <br />ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION <br />The ACORD name and logo are registered marks of ACORD <br />Ri �e ManPgenYmLDirtisian <br />REVIEWED & APPROVED Br <br />T[IDL.u-gY./K F1f..hFiNe2 Tom. VeLW1:Y; <br />�' R¢X Managemen[Analyst <br />
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