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Oct 21 04 11:51a FITNESS and WELLNESS 8585190822 p•2 <br />OW , <br />SANTA ANA RISK MGMT. Fax:714-647-5311 Oct 14 2004 16:58 P.02 <br />ACCRD <br />------,11. CERTIFICATE OF LIABIL[ <br />INSURANCE <br />DATE (MMro01YYYY) <br />I 0927=1104 <br />PRODUCER <br />FITNESS AND WELLNESS INSURANCE AGENCY <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF WpORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />380 STEVENS AVENUE, SUITE 205 <br />HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />SOLANA BEACH CA 92075 <br />Aomej udr. ao28716 <br />INSIERS <br />AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />JORGE A. HIGUERA Al ' a003 -0?'[ <br />INSUR <br />A: Zurich Americaln Insuranca Company <br />INS <br />R B: <br />C/O KARATE DO 019NAWA <br />AVE. /�- 03- d'7 7-t�l <br />INSUR <br />R C <br />INSUR <br />R D: <br />501 N COMMONWEALTH <br />4 <br />INSUR <br />R E <br />FULLERTON CA 92831 <br />THE POLICIES OF INSURANCE LISTED 52m HAVE BEEN ISSUED TO THE INSURED <br />ANY REQUiR17uENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT W <br />!MY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON IS <br />POLICIES. AGGREGAIE.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />RESPECT TO WHICH THIS CERTIFICATE MAY BE L4SUED OR <br />CT TO ALLINE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY <br />DATE <br />crave <br />Woo <br />POLICY ENPIiATAN <br />LIMIT$ <br />A <br />GENE LLIABILIfY <br />X COMMERCIALGENERAL LV�BBJ <br />CLAIMS MANE OCCUR <br />GEN'LAGGREGATELIMITAPPLIESPFiC <br />X POLICY LAC <br />Ep 012M-00 <br />1011r04 <br />10M1l05 <br />EACH OCCUR <br />$ 1.000.000 <br />DAWaETDRENTED <br />$ 100.000 <br />MED. EW'WryamPeraorr) <br />$ 2,500 <br />PERSONAL &ADV INJURY <br />$ 10D0000 <br />G H&RALAGGREGATE <br />$ 3.000.000 <br />PRODUCTSCOMPIOPA=. <br />S 3,00III'm <br />AUTOMOBILE LIASILr;Y <br />ANYAUTO <br />ALL OPINED AUTOS <br />SCHEDULEDAUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />COMBINED MNGLE UMIT <br />(Ea aeddent) <br />$ <br />80DILY INJURY <br />(Per person) <br />$ <br />BOIXYIWURY <br />(I'cr Cacidill <br />S <br />PROPERTY DAMAGE <br />Per acek%nt <br />3 <br />GAWA EUABILnY <br />ANYAUTO <br />AlITOONLY -EAACCI ea <br />S <br />OTHERTHAN EA ACC <br />AUIC) ONLY: <br />9i <br />E7(CESS I UMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />DFDWTJBLE <br />RETENTION $ <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />i <br />S <br />S <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LJANI-TY <br />ANY vRwNEETgwLPARTNER&EO1mvE <br />OFacERNAEM EREXcLUDED9 <br />Il 0 <br />ION <br />SPEC .L9 PROP)tOY1S10NS Colav <br />/ <br />E <br />we suTu <br />oft <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISSEl E-EA EMPLOYEE <br />S <br />Be .L DIZIMME-POLICY Liki <br />S <br />OTHER_ <br />DESCRIPTION OF OPERATIONS!LOCATIONSNMICL.ES=CLUSIONS ADIDED <br />CERTIFICATE HOLDER ADDED AS ADDRIONAL INSURED ONLYAS THFIF <br />BY ENDORSEMENT/ SPECIAL PROVISIONS <br />INTERESTS MAY APPEAR. <br />Tho City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br />Attsnfilm <br />ACORD 25 (20011N) C8difil t: # 8515 <br />ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE <br />ON DATE THEFJ=OF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 <br />IMEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUY <br />TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br />, ITS AGeNTS OR REPRESENTATIVES. <br />