Laserfiche WebLink
- -JIVUCERTIFICATE OF LIABILITY INSURANCE 10,29,2007 <br />IA00) 395-ems rar (858l 5I9-087; THIS CERTIFICATE IS ISSUED AS A MATTER OF <br />FITNESS AND WELLNESS INFORMATION <br />9 3F.0 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC{ TE <br />BEACH CA 92075 Q OR <br />JORGE A. HIGUERA <br />DBA KARATE DOOKINAWA <br />925 E LA VETA AVE SPC# 26 <br />07AKIGE CA 92866 <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A: Philadelphia Indemnity Insurance Company <br />INSURER B' <br />INSURER C. <br />INSURER D: <br />INSURER E: <br />_ISTED BELOW HAVE BEEN ISSUED TC TIFF INSURED NAMED ABOVE FOR THE POLICY FERIOD INDICATFD, NCTW )HSTANDING <br />==O.,IREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VGITI RESPECT TOWHICH THIS CEP-IFICATE MAl BE ISSUED r!R <br />�_ <br />-•rcTA�VI, TIC INSURANCF AFFORDED BY THE POUCICS DESCRIBED HEREIN IS SUBJECT TC� ALLTHE TERMS, EACLUGIONS AND CONDIT'ONS CF SUCII <br />A3'3RE3ATE LIMITS SHOWN MAY HAVE BEEN REDUCED BF PAID CLAMS <br />T 7. NSURANCE <br />POLICY NUMBER <br />POLICY EFFECnVE <br />DATE MM/DDNY) <br />POLICY EXPIRATION <br />DATE (MKVDNY) <br />LIMITS <br />- - "L -' <br />PHPK215316 <br />10/11/07 <br />10/11/08 <br />EACH OC_URPFNICF <br />1,000,000 <br />. _ fi.A '_'•+a"_IT 1' <br />--A9NS fvIADC OCCUR <br />L, MOE TO DENTED <br />PRFMISFS IF:. u:r ..en: e1 <br />100,000 <br />MED E:'P 'Ary onn po,cri) <br />P 2,500 <br />PEUS,NAL .z ADW I1I.;IJPY <br />6 1,000,000 <br />OCNCR.AL Ac3GREGATC <br />$ 3,000,000 <br />GEN'L AGGREGATE LIMI-APP'_IES PER <br />PPv- <br />X I POLICY oc <br />F'F'VDJrTS i �::MPnJP AGE- <br />t 3,000,000 <br />A'J'CVOBILE LIABILITY <br />—__ <br />COfd81NEC SIh,;LE LIMIT <br />- -%_TO <br />(Ea accdent) <br />AALL OWNF-, AI IT,-.'; <br />SCHEDULED AUI <br />F,,Wdl t' INJNLR1 <br />(Pe, po Snn) <br />1 HIRED A'JTCS <br />- n.�1 AI_TCS <br />� <br />BODILY IPLIOR` <br />IPdi Ali InAnt) <br />RROPERT1 DAMAGE <br />(, <br />- - --- --- <br />_ <br />I Per ac adentj <br />GA4AGE LIABILITY <br />AUTO ONLY - EAA:CICENT <br />OTT IEP TIIAI, CAAC- <br />_I,u,;Y AJ10 <br />AU-0 ONLY AO,., <br />l <br />Ed:°SS! UVBRELLA LIABILITY <br />EACH OCCURRENCE <br />6 <br />MADE <br />AOCRFC,ATE-- <br />6 <br />DEDUCTIBLE <br />6 <br />RETENTION $ <br />F <br />- <br />we srA" OrHE9 <br />T_RY LIMITS <br />EL EA,-H ACCIDENT <br />F <br />- c•EteXEccrne <br />.. . � :><O. !DED9 <br />t <br />a <br />1 �) y?!� <br />� <br />E L. DISEASE -EA EMPLOYEE <br />T ^!- <br />F L DISEASE -POLICY L MIT C <br />CESCRIPTION OF OPERATIONS/LOCATIONS)'VEHICLES/EX i S ZOED$N'ENDIORSEMENT/ SPECIAL PROVISIONS <br />e•s`ood and agreed that the following entity is added as an additional insured but only as respects the operations of the named i <br />"?',P;+v resulting from the additional insureds sole negligence. This Policy is Primary and Non-contributory. <br />Ora'. insured Endorsement is Effective: 10/11/07 SEE ATTACHED ADDITIONAL INSURED ENDORSEMENT CG 20 26 11 15 <br />. "a <br />"s Agents, Officers, Volunteers, Employees SI <br />?�a-esentatives <br />1 888 W. Santa Ana Blvd Suite 200 <br />cC Box 1988 M-23 <br />'_ • _ <.. 8) ^ Certificate# 64839 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DEr)RF Tr- <br />F$PIRATII'JN FIAT= THFRFOF 711F iRSUIIJI; INSJRFR WIII FNFIFAVJRT I IAII ICI <br />DAYS INP17FPI LOI ICE <br />TO ]HE <br />-ERTIFb_ATE IOLDEP P.A^4EC TO THE L:=T BUT <br />FAILURE T! DO�:' SHALL IMPVF.E GL;1 OBLIGHTION OR LIABILITY JF V1Y P;I JC UrGN THE <br />INSURER, IT'S AGENTS OR RCFRCSENTATIVCS <br />9 C • .7A.;.,f <br />rey E. Frick, CEO <br />© ACORD CORPORATION 1988 <br />jred <br />