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ACORD. <br />PRODUCER <br />Fitness & Wellness Insurance <br />Agency <br />380 Stevens Ave., First Floor <br />Solana Beach CA 92075 <br />Phone=800-395-8075 Fax=858-519-0822 <br /> <br />INSURED <br /> <br />CERTIFICATL OF LIABILITY INSURAN( ' oP D DATE M.DD I <br /> 03~4688 / 04/lS/03 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />STKD Club 0374688 <br />Jorge Nunez <br />Effective= 1/1/03 . <br />13692 Newhope St. <br />Garden Grove CA 92843 <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />INSURERA: S[~ecialt}, National Insuranc* <br />INSURER B: <br /> <br />INSURER C: <br /> <br />INSURER D: <br /> <br />INSURER E: <br /> <br />~IAIC # <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAy SE 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 /> <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> <br />TYpE OF INSURANCE POLICY NUMBER <br /> <br /> GENERAL LIABILITY <br /> <br /> COMMERCIAL GENERAL LIASILITY <br /> <br />__ CLAIMS MADE ~ OCCUR <br /> <br />3XZ126451-02 <br /> <br /> DEDUCTISLE <br /> RETENTION $ <br /> <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTiVE <br />OFFICER/MEMBER EXCLUDED? <br />If es, descdbeunder <br />SI~ECIAL PROVISIONS below <br /> <br />POLICY EFFECTIVE <br />DATE (M M/DO,'YY) <br /> <br />ol/oi/o3 <br /> <br />OTHER <br /> <br />Sexual Abuse <br /> <br />POLICY EXPIRATION <br />DATE (MM/DD/YY) <br /> <br />oi/o1/o4 <br /> <br />LIMITS <br /> <br />EACH OCCURRENCE <br /> <br />PREMISES (fa occurence} <br />MED EXP (Any one person) <br /> <br />$1~000,000 <br />$100,000 <br />l$2,5o0 <br /> <br />PERSONAL&ADVINJURY $ 11000, 000 <br />GENERAL AGGREGATE $3z000,000 <br />PRODUCTS - COMP/DP AGG $ 1, 000, 000 <br /> <br />COMBINED SINGLE LIMIT <br />(fa accident) $ <br /> <br />BODILY rNJURY $ <br />(Perperson) <br /> <br />BODILY INJURY <br />>er accident) <br /> <br />PROPERTYbAMA~E <br />(Peracciden~) <br /> <br />AUTO ONLY - EA ACCIDENT <br /> <br />OTHER THAN EA AC, <br />AUTO ONLY: AGG <br /> <br />EACH OCCURRENCE <br />AGGREGATE <br /> <br />WC S rATU- O ] H- <br /> <br />E.L. DISEASE - EA EMPLOYEE <br /> <br />E.L. DISEASE - POLICY LIMIT <br /> <br /> 3XZ126451-02 100,000 <br /> 300,000 <br /> AP. PR. OVED AS TO FORM <br />kcity of Santa Ana, its officers, employees, agents and representatives <br />~amed as additional insured per the attached form CC2010 11/85, ~. ~ _ ~ <br /> Latfra~}cedy -~---'----------'--"- <br /> Deputy City Attorney <br /> ERTIFICATE HOLDER cANcELLATION <br /> <br />SA/~ANAT <br /> <br />The City of Santa Ana* <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br /> <br />ACORD 25 (2001108) <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> <br />DATE THEREOF, THE ISSUING INSURER WILL~I~ TO MAIL 30 DAYS WRITi' E N <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />Jeffrey E. Frick <br /> <br />© ACORD CORPORATION 1988 <br /> <br /> <br />