ROBLES, DENISE (2) - Laserfiche WebLink

Home Browse Search

Francine R. DlgftMly slyned by Fandne% Villareal Villareal Data; 2021.07.2009:05:45 07.00• ACORO® CERTIFICATE OF LIABILII Y INSURANCE DAM(MMIODNYYY) 05/14/2021 THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONL AND CONFERS N RIGHTS UPON THE CERT FICATE 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 OR PRODUCER, AND THE CERTIFICATE HOLDER. BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE 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 K&K Insurance Group, Inc. 1712 Magnavox Way C TAC E: Mass Merchandising Underwriting PHO E FAX AIC No Ext: 1-800-506-4856 A/c No: 1-260-459-5590 ADDRESS: info@fitnessinsurance-kk.com Fort Wayne IN 46804 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAICM INSURED Denise Robles 1664 W. Cindy Ln Apt #6 Anaheim, CA 92802 INSURER A: Nationwide Mutual Insurance Company 33787 INSURER B: INSURER C: A Member of the Sports, Leisure & Entertainment RPG INSURER D: INSURER E: INSURER F: COVFRAr.FF n�......... r� .......,..�. ..,_._.___. __......_,.. _ . ,,.....�... ...,,��.,�., KI-VISIUN NUMBER: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMN MM/D OMITS A X COMMERCIAL GENERAL LIABILITY MADE OCCUR ❑X OCCUR X 6BRPG000OD07446000 06/01/2021 12:01 AM EDT 06/01/2022 12:01 AM EACH OCCURRENCE $1,000,000 PREMISES Ea Occurrence $1,000A0 MED EXP(Any are person) $5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY PRO- ❑LOC OTHER: PRODUCTS-COMPIOP AGG $1,000,000 PROFESSIONAL LIABILITY $1,000.000 LEGALLIAB TOPARTICIPANTS $1,000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS SCHEDULED ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS Y NOT PROVIDED WHILE IN HAWAII Ea accident BODILY INJURY (Per person) BODILY INJURY (Per accident) Per accident UMBRELLA LIAR1-1 OCCUR EXCESS UAB CLAIMS -MADE DED El RETENTION EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION ANO EMPLOYERIETOR ILRY ETOR/P /MEMB / YIN ANY EXECUTIVE EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NHl 0 yes, dear be under DESCRIPTION OF OPERATIONS below N/A PER STATUTE OTHER E.L. EACH ACCIDENT EL DISEASE -EA EMPLOYEE EL DISEASE -POUCY LIMIT MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more apace Is required) Certified Instructor of Aerobics, ZUMBA The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. CFRTIFICATF Nnl IIFR ....... �... _._.. 20 CIVIC Center Plaza Santa Ana, CA 92702 (Owner/Lessor of Premises) REPRESENTATIVE Coverage is only extended to U.S. events and activities. NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and ACORD 25 (2016103) ©1988-2015 The ACORD name and logo are registered marks of ACORD BE DELIVERED y,?^_.,�x IcwrAlaiugemoit U[vMlon RENEWED&APPR�O�V/ DBYE: S FAFKNI.[ Z VaKNIP/.c • RUk Management Anayst