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.' ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) TM 10/04/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MA ITER OF INFORMA liON FITNESS AND WELLNESS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 380 STEVENS AVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SOLANA BEACH CA 9207S ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE -I NAIC# Agency LiC#, 0028716 " . -~- Steadfast Insura':1E~ Company ----- INSURED N- ;)Ot>,j - o9b IINSURE'R A:. +- - DANIEL RAMIREZ INSURER B: 13901 FERNWOOD tJ- ~3 -- 0%-01 -..--- --.. INSURER C: - GARDEN GROVE CA 92843 - T ------ INSURER D: _._0- INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADD'L TYPE OF INSURANCE LTR INSRO GENERAL LIABILITY ~,M.,M, ERCIAl GENERAlllABllI" ~ CLAIMS MADElX' OCCUR POLICY NUMBER ~OLICY EFFeCTIVE DATE MMIODNY 11/10/03 I P~.i~EY'~~~~'" i LIMITS - ---- 11/10/04 I EACH OCCURRENCE 4== 1,000,000 !OAMAGETORENTED- $ 10000'0 ,.PFFUI~F~ IF. t\tV""....n~"l) _. ____ .m . .~_ ____ , MED. EXP (Any Dne person) $ 2,500 PERSONAL & ADV INJURY $ _ 1,000,000 ~~NERAL AGGREGATE $ 3,<!.~O,OO~ PRODUCTS.COM~!~ AGG. $ __"_ 3,000,000_ EOLS281394-Q0 A GEN'L AGGREGATE LIMIT APPLIES PER: ----xl POLICY iUl PROJECT n LOCi ,I AUTOMOBILE LIABILITY III ANY AUTO , ALL OWNED AUTOS :~.. SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS -~ COMBINED SINGLE LIMIT I ~:~:~:~~RY 1$ -- (Per person) 1$ BODILY INJURY t- (Peracddent) PROPERTY DAM~GE--- : ' (Per accident) GARAGE LIABILITY I~' ANY AUTO I' EXCESS I UMBRELLA LIABILITY J OCCUR D CLAIMS MADE ~ DEDUCTIBLE II I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED? lfyell,dncrlbeund.r i SPECIAL PROVISIONS below I J)?j _ '~~Alj2-: ' !dV',1 1.' , I' I I I AUTO ONLY. EA ACCIDENT $ OTHER THAN __10 ACC $ AUTO ONLY: ..-..-. .$ EACH OCCURRENCE $ $ -._--- .f:-=- -== ! I:^,CSTATU- i I OTHER I f--, E.L. EACH ACCIDENT 1$ I AGGREGATE_ _ _.:. E.L. DISEASE-EA EMPLOYEE " E.L. DISEASE-POLICY LIMIT s,____ $ OTHER: I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER ADDED AS ADDITIONAL INSURED ONLY AS THEIR INTERESTS MAY APPEAR. CERTIFICATE HOLDER The City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, Irs AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~~~ Jeffrey E. Frick, CEO 0028716 @ACORDCORPORATION1988 Attention: ACORD 25 (2001/08) Certificate # 9293