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ACORQ• CERTIFICATE W LIABILITY INSURANCLW n,OP IDc RBI DATE <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 />Choc V. Le #0375057 <br />Eff: 01-06-03 <br />4 Fabriano <br />Irvine CA 92620 <br />COVERAGES <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 />INSURERS AFFORDING COVERAGE <br />INSURER A: Specialty Natio <br />INSURERS: <br />INSURER D: <br />INSURER E: <br />NAIC 0 <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 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 />LTR <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MMN <br />DATE MWDDIYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />f1,000,000 <br />A <br />X <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE FX� OCCUR <br />3XZ126451-02 <br />01/06/03 <br />01/06/04 <br />PREMISES Eaaccurence <br />$100, 000 <br />MED EXP (Any one Person) <br />$2 , 5 0 0 <br />A <br />X Nisc.Professional <br />PERSONAL SADVINJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />f3,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS-COMP/OP AGO <br />$1,000,000 <br />POLICY JECTT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Par person) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY <br />(Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />GARAGE LIABILITY. <br />AUTO ONLY - EA ACCIDENT <br />S <br />ANY AUTO <br />OTHERTHAN EA ACC <br />AUTO ONLY: AGO <br />$ <br />S <br />EXCESS/UMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />S <br />S <br />S <br />DEDUCTIBLE <br />RETENTION S <br />$ <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />TORV LIMITS ER <br />E.L. EACH ACCIDENT <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />H yez, desWbe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -EI EMPLOYE <br />f <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />OTHER <br />ASexual <br />Abuse <br />3XZ126451-02 <br />100,000 <br />300,000 <br />)ESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES IEXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ��kU VL"'� AS 1U FORM <br />It is understood and agreed City of Santa Ana, its officers, gents, 1' <br />employees, representatives, and volunteers are added as addition <br />insuered per the attached form CG201011/85 <br />L.,idfq , Needy <br />I1kcpNiy City Attorney <br />SANANAC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI( <br />DATE THEREOF, 30 DAYS WRITTEN <br />City of Santa Ana Parka and NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, - <br />Recreation, & Community <br />Services Agency aIERIIEEEIEIIIsI� <br />P.o. Sox 1988 U-23 <br />Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2001/08) <br />