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ACCOREI CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />02/12/2020 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />KBK Insurance Group, Inc. <br />1712 Magnavox Way <br />Fort Wayne IN 46804 <br />CONTACTNAME: Ma s$ Merchandising <br />_ <br />ac No Est: 1-800-648-6406 a0 Net: 1-260-459-5940 <br />EMAIL <br />ADDRESS: info@danceinsurance-klLcom <br />PRODUCER <br />CUSTOMER M: <br />INSURERS AFFORDING COVERAGE <br />NAIC8 <br />INSURED 001219054 CPk 251 <br />Raquel Gutierrez <br />3101 S. Fairview Stiff <br />Santa Ana, CA 92704 <br />A Member of the Sports, Leisure 8 Entertainment RPG <br />INSURER A Nationwide Mutual Insurance Company <br />23787 <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 2000458303 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 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 PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />MD <br />SUER <br />WVD <br />POLICY NUMBER <br />POLICY SEE <br />POLICY UP <br />MWDD/YY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL UABILITY <br />CLAIMS ❑X OCCUR <br />X <br />6BRPGOOD00 O7214200 <br />02/10/20 <br />12,01 AM <br />44 <br />02I0121 <br />12:O1 AM <br />EACH OCCURRENCE <br />$1,GOO,000 <br />DAMAGE TO RENTED <br />PREMISES Ea Occummes <br />$11000,000 <br />MED UP (Any one person) <br />$5,000 <br />PERSONAL A ADV INJURY <br />$1,O0O1DDO <br />GEN'L AGGREGATE LIMIT AP PLIES PER: <br />POLICY ❑ PROJECT LOC <br />GENERAL AGGREGATE <br />$5,DOO,OOO <br />PRODUCTS—COMP/OP AGO <br />$1,0001000 <br />OTHER: <br />PROFESSIONAL LIABILITY <br />$1,000,0()0 <br />LEGAL LIAR TO PARTICIPANTS <br />$1,000,000 <br />AUTOMOBILE <br />LIABILITY <br />acd4om L (Ea <br />BODILY INIURY (Per person) <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per awclenl) <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per ecdtlenl <br />X <br />Not provided while in Hawail <br />UMBRELLA LIAB OCCUR <br />EACH OCCURRENCE <br />EXCESS UAB CLAIMS -MADE <br />AGGREGATE <br />DEO RETENTION <br />WORKERS COMPENSATION <br />AND EMPLOVERS'LIABILITY <br />WA <br />PER STAME OTHER <br />ANY PROPRIETONPARTNER/ Y I N <br />EXECUTIVE (Mandatory <br />EXCLUDED? (Mandalory In NH) <br />Il yes desnllas antler <br />DESCRIPTION OF OPERATIONS be:ow <br />E.L EACH ACCIDENT <br />EL DISEASE —EA EMPLOYEE <br />E.L. DISEASE —POLICY LIMIT <br />MEDICAL PAYMENTS FOR PARTICIPANTS <br />PRIMARY MEDICAL <br />EXCESS MEDICAL <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1D1, Additional Remarks Schedwe, may be eltache4 i1 mare apace Is mpVimd) <br />Certified Instructor of: ZumbaO / <br />City of Santa Ana, its officers, agents, employees, and volunleers are added as an additional insured, but only for liability Caused, in whole or in part, by the <br />acts or omissions of the named insured. !!! <br />This certificate voids and replaces certificate If W01677331. <br />ctHurlcAlt "ULULK / CANCELLATION <br />�k Management Division / <br />Civic Center Plaza ✓ REVIEWED & <br />me Ana, CA 92702 By Risk ManaGl <br />Iner/Manager/Lessor of Premises <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />W)@(VQ4 DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH <br />ACEVEdo <br />Coverage is only extended to U.S. events and activities. <br />NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />