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<br />~dmjnistrative Office <br />1400 American Lane <br />Schaumburg, Illinois 60196 <br /> <br />N-~OD3-09h <br /> <br />STEADFAST INSURANCE COMPANY <br />A ZURICH COMPANY <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br />Policy Number: EOl5281394-00 <br />Fitness and Wellness Purchasing Group Certificate Number: 0393366 <br /> <br />NAMED 0393366 Daniel Ramirez AGENT Fitness and Wellness Insurance Agency <br />INSURED NAME AND 380 Stevens Avenue, #115 <br />AND 13901 Fernwood MAILING Solana Beach, CA 92075 <br />MAILING ADDRESS <br />ADDRESS Garden Grove. CA 92843 800-395-8075 - L1C#OD28716 <br /> <br />POLICY PERIOD: From: 11/10/03 To: 11/10/04 <br />THIS CERTIFICATE OF LIABILITY INSURANCE FORMS A PART OF THE POLICY REFERENCED ABOVE. <br />INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCEt AND CONVEYS ALL THE RIGHTS AND <br />PRIVILEGES AFFORDED UNDER THE POLICY. THE INSURANCE COVERAGE PROVIDED UNDER THIS <br />CERTIFICATE IS SUBJECT TO ALL THE TERMS. CONDITIONS, AND EXCLUSIONS OF THE POLICY <br />IDENTIFIED ABOVE. <br /> <br />COVERAGES LIMITS OF INSURANCE <br />Bodily Injury. Property Damage or $1.000.000 Each Occurrence Lim it <br />Professional Incident <br />Personal and Advertising Injury Limit $1,000,000 Anyone Person or Organization <br />- <br />General Aggregate Limit (Other than $3,000,000 <br />Products/Completed Operations) <br />Products/Completed Operations $3,000,000 Aggregate Limit <br />Coverage 0 Medical Expenses $ 2,500 Any One Person <br />Coverage E Sexual and/or Physical Abuse liability $ 100,000 Each Claim Limit! <br /> $ 300,000 Annual Aggregate Limit <br />Coverage F Employer's Liability (Only available in Only In State(s) where this Insurance applies: <br />the following States: NO, OH, WVA. WA and WY) $ 100,000 Bodily Injury by Accident - Each Accident <br /> $ 100,000 Bodily Injury by Disease - Each Employee <br /> $ 500,000 Aggregate Limit - Employer's liability <br />Damage to Premises Rented to You $ 100,000 Any One Premise <br />The most we will pay for any occurrence, or related occurrence that triggers Bodily Injury, Property Damage or <br />Professional Incident or any combination thereof is the each occurrence limit. Payments made under Sexual andlor <br />Physical Abuse. Medical Expenses, Employers liability (where applicable), and Damages to Premises Rented to You <br />deplete the general aggregate limit of liability. <br />Location of all premises you own. rent or occupy: <br />1) Various <br /> <br />Premium: <br />RPG FEE: <br />Taxes/Filing Fees: <br /> <br />234.00 <br />Included <br />Included <br /> <br />IF YOU HAVE ANY QUESTIONS CONCERNING THIS CERTIFICATE CONTACT: <br />FITNESS AND WELLNESS INSURANCE AGENCY - 800-395-8075 <br /> <br />Jeffrev E. Frick <br />Authorized Representative <br /> <br />Form #: Cert1 <br /> <br />NOVEMBER 17.2003 <br />Date <br /> <br />,&/ - ., .../.J, ///2.- <br />~~t~//( <br />/ <br /> <br />