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F <br />DATE (MM /DD /YYVY) <br />A CORD <br />TM. CERTIFICATE OF LIABILITY INSURANCE 03/0812005 <br />PRODUCER Phone: (800) 395-8075 Fax: (858) 519 -0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF <br />FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION <br />380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />SOLANA BEACH CA 92075 <br />INSURERS AFFORDING COVERAGE I NAIC # <br />INSURED r/ ,...,.,.�.. <br />STKD.CLUB /V _ c�l�V `%— 0r7(0 INSURER B: <br />JORGE NUNEZ INSURER C: <br />13692 NEWHOPE ST. <br />GARDEN GROVE CA 92843 INSURER D: <br />INSURER E: <br />COVERAGtb <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 />INSRADVL <br />LTR <br />INSRO <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DRTE MIND <br />POLICY <br />DATEEXPBATwN <br />DATE MMIDD <br />LIMBS <br />REPRESENTATIVES & VOLUNTEERS <br />888 W. Santa Ana Blvd. <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILI <br />EOL9012327 -00 <br />01/01105 <br />01101106 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PREMISES(Ex amumnx) <br />$ 100,000 <br />MED. EXP (Any one person) <br />$ 2,500 <br />CLAIMS MAD X OCCUR <br />PERSONAL B ADV INJURY <br />$ 1,000,000 <br />A <br />GENERAL AGGREGATE <br />$ 3,000 000 <br />GEN'L AGGREGATE LIMIT APPLIES PE <br />PRODUCTS- COMP /OPAGG. <br />$ 3,000,000 <br />X POLICY F PR' LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY <br />(Per person) <br />$ <br />ALL OWNED AUTOS <br />SCHEDULEDAUTOS <br />BODILY INJURY <br />(Per accident) <br />$ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />$ <br />Per accident <br />GARAGE LIABILITY <br />AUTO ONLY - EA AC IDENT <br />$ <br />OTHER THAN EA ACC <br />$ <br />ANY AUTO <br />AUTOONLY: AGG <br />EXCESS / UMBRELLA LIABILITY <br />OCCUR � CLAIMS MADE <br />DEDUCTIBLE <br />APPROV <br />1 <br />D AJ TO F <br />'T <br />"M <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />$ <br />RETENTION$ <br />LaUf <br />COMPENSATK)N AND <br />/�SSISta <br />TORYLMWORKERS <br />E.L. EACH ACCIDENT <br />$ <br />EMPLOYERS' LIABILFY <br />My PROPRIETOR/PARTNERIEXECUTIVE <br />OFFICENMEMBER EXCLUDED? <br />tt <br />E.L. D ISEASE-EA EMPLOYEE <br />$ <br />ByRF, ens. `Una., <br />SPEC doscri lswxS <br />ml- <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 INSURE <br />ONLY AS THEIR INTERESTS MAY APPEAR. <br />ACORD 25 (2001/08) <br />Certificate # 1 14U <br />wAl Vmu MVrm v.nVn 1woo <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 Recreation <br />ITS OFFICERS, AGENTS, EMPLOYEES <br />REPRESENTATIVES & VOLUNTEERS <br />888 W. Santa Ana Blvd. <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 <br />Cam/ <br />Attention: <br />Jeffrey E . Frick, CEO <br />ACORD 25 (2001/08) <br />Certificate # 1 14U <br />wAl Vmu MVrm v.nVn 1woo <br />