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i <br />"9"xS,,a ��r J'_aJ. YO ,OJOJa Juoc.t: rA IIYCJS HIYU Wtllµ,me'-s. _; <br />AcoRo. `CERTIFICATE OF LIABILITY INSURANCE 63 <br />PROOUCER THIS CERTIFICATE 15 ISSUED AS I <br />Fitness A wellneas Insurance ONLY AND CONFERS NO RIGHTS <br />Agency HOLDER. THIS CERTIFICATE DOE! <br />3110 Stevens Ave., First Floor ALTER THE COVERAGE AFFORDE <br />Solana Beach CA 92075 <br />Phone:000-395-8075 Fax:856-519-0822 INSURERS AFFORDING COVERAGE <br />INCURBL A. Steadfast Insurance <br />Jorge A. SiqUera R302055 01a Specialty National insuranc <br />Karate Do OTiinawa Eff:10/11/03 INSURER C, <br />501 N Commonwealth Ave i4 INSURER D. <br />Fullerton CA 92031 <br />NAIC 8 <br />n4E POLICIES OF INSURANCE LISTED BELOW HALIE BEEN ISSUED TO THE INSURED "VIED ABOIM FOR THE POLICY PERIOD INDICATED. NC NRTHStANDING <br />ANY REQUITEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO NMICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY TM POLICES DEWRBED HEREIN M SUBJECT TO ALL THE TERMS, E%CLUSICNS AND CONDITIONS OF SUCH <br />POLICIES. A0GREGATE LIMITS SHODNN MAY HAVE BEEN REDUCED BY PAID CLAMS. <br />LTR <br />TYPE OF INMMANCE <br />POLICY NIaIeER <br />DATE <br />DATE <br />LIMES <br />OBNERAL LIABILITY <br />EACHOCCURREHCE <br />I51,000,000 <br />A <br />X <br />X COMMURCNALOEMERALUAmUTY <br />OAat41MDE Fx-]OCCU! <br />E0145281391-00 <br />10/11/03 <br />10/11/04 <br />PRdlsFis REF weu1; <br />100,000 <br />NED ED(P(Arw Iwo FFMM+) <br />$2 500 <br />P9 MALa ADN MANTY <br />s1,000,000 <br />A <br />X I Wsc. Professional <br />_ <br />O@FPALAGGRBOATE <br />s3,ODO,000 <br />0ENLAGGRS.ATELWAPPLIFSPBC <br />PRODUCTS. COMPIDPAGO <br />Is INCLUX)ED <br />POLICY LOC <br />"TOMODR.E <br />LMILM <br />ANYALITO <br />COMBINED aMDLG UNIT <br />IBaANPAAO <br />s <br />ALL OWNEDAUTOS <br />SCHEDLLrON.ROS <br />BODILY USABLY <br />Leer WWII) <br />S <br />MREDAUTOS <br />NOFLOMRIED AUTOS <br />BODILY IN.URT' <br />(PW.-d'^O <br />s <br />OARAGELIABLR'/ <br />�..'...... <br />AUTO ONLY. FAACGOENT <br />s <br />ANYAUTp <br />- <br />- <br />f <br />UTO THA tACO <br />AUTO ONLYN: AGC <br />5 <br />S <br />-AC63MMBRe.U1 LIABILITY <br />OCCUR CLAIMSMADE <br />{ t ? n I r I ` ' <br />EACH OCCURRENCE <br />5 <br />AGC-RETATE <br />S <br />S <br />- <br />, ^ <br />OEOUGTIBLE <br />RETENTION T <br />s <br />WORNRRBCOMPENBATION AND <br />EMPLOYERS L"ILITY <br />TORT INT <br />E.L EACH ACCIDENT <br />_.-- <br />$ <br />ANYPROPRIETORAMRTMLFIE7LeVDVE <br />DPyeFALT3VA®A�R OlCLUO� <br />9IR3.TAL PROViSIOFS CdaN <br />EL DISEASE - EA EMPLOY <br />s <br />E.L.DIEEASE. POLICY LIMIT <br />5 <br />OTHER <br />A sexual Abuse <br />ZOL5281394-00 <br />Occ- 100,000 <br />300 000 <br />DEsdtIPTION OC OPETAiIONs/LOCATIONS IVBNICLES I EICLUSIONS ADDED BT 8MRSOAENTT SPECIAL PROVISIONS , <br />It is understood and agreed that the following entity is added as an <br />additional insured but only as respects the operations of the named insured <br />except that liability resulting from the additional insureds sole negligence <br />PIIIPI � a I <br />The City of Santa Ann <br />20 Civic Center Plata <br />Santa Ana CA 92701 <br />OCT-09-2003 15:56 <br />CTTOSJw SHOULD ANY OF THE ABDYE DESCRIBED IAT Ian EE CANCELLED BEFORE THE EKARAT <br />DATETHMeOF,THEISS1 WINSURE Ww ENOEAWRTONAIL 3D DAYS WRTrtE <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHAI <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR <br />AUTHORRED REPRESENTATNE <br />Jef£rev E. Frio <br />V ACORD CORPORATION <br />8585190822 97% P. 03 <br />