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KP✓\t --g-y }tiv c rD IZ <br />ACORDTM. CERTIFICATE OF LIABILITY INSURANCE OAT1103/2005� <br />PRODUCER Phone: (800) 395-8075 Fax: (858) 519-0822 <br />FITNESS AND WELLNESS INSURANCE AGENCY <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />380 STEVENS AVENUE, SUITE 206 <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />SOLANA BEACH CA 92076 <br />INSURERS AFFORDING COVERAGE NAIC # <br />Agenc Lic#:OD28716 <br />INSURED <br />JORGE A HIGUERA . �p�j J <br />INSURER A: Zurich American Insurance Company <br />INSURER B: <br />DBA KARATE DO OKINAWA <br />1000 W. MACARTHUR BLVD <br />INSURER C: <br />INSURER D: <br />SUITE #130 <br />INSURER E: <br />SANTA ANA CA 92707 <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />ADD'L <br />INSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICYEFFECTIVE <br />DATE MIWD <br />POLICY EXPIRATION <br />IW DATE MO <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE EX:] OCCUR <br />EOLS012327-01 <br />10/11/06 <br />10/11/06 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />$ 100,000 <br />DAMAGE TO RENTED <br />PREMISES (Ea occurence) <br />MED. EXP (Any one person) <br />$ 2,500 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />PRODUCTS-COMP/OP AGG. <br />$ 3,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRCTO LOC <br />X E <br />J <br />$ 3,000,000 <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY <br />(Per person) <br />$ <br />BODILY INJURY <br />(Per accident) <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />$ <br />GARAGE LIABILITY <br />ANY AUTO <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />AUTO ONLY: AGG <br />$ <br />$ <br />EXCESS / UMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />i <br />DEDUCTIBLE <br />RETENTION $ <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />S <br />$ <br />$ <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY- <br />ANYPROPRIETOR/PARTNER/EXECUTNE <br />OFFICERMEMSER EXCLUDED? <br />If yes, descrlbs under <br />SPECIAL PROVISIONS babes <br />I WC SY LIMITTA.T S OTHER <br />TOR <br />_ --- <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />OTHER: <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED <br />ONLY AS THEIR INTERESTS MAY APPEAR. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />CITY OF SANTA ANA <br />PARKS, RECREATION, & COMMUNITY SERVICES AGENCY <br />888 W. SANTA ANA BLVD, SUITE 200 <br />AUTHORIZED REPRESENTATIVE <br />`• <br />PO BOX 1988 M-23 <br />SANTA ANA, CA 92702 <br />Attention: PEGGY L CALVERT <br />Jeffrey E. Frick, CEO <br />ACORD 25 (2001/08) Certificate # 30781 © ACORD CORPORATION 1988 <br />