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ACORD CERTIFICATE OF LIABILITY INSURANCE <br />TM. <br />OAT02128/2007) <br />PRODUCER Ptm,: (800)385-8W5 Fm: (858)519-0 22 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF <br />FITNESS AND WELLNESS INSURANCE AGENCY <br />INFORMATION <br />380 STEVENS AVENUE, SUITE 206 <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />SOLANA BEACH CA 92075 <br />INSURERS AFFORDING COVERAGE <br />NAIC If <br />2B716 <br />INSURED_ _ A _ aQQ3 _ 95 <br />INSURER A: Zurich American Insurance Company <br />INSURER B: - <br />_ <br />KARATE DO KIAIC/O MARTIN ORRES N `oj O D,'j - 0 �-O� _ <br />12692 RANCHERO WAY a <br />INSURER C: <br />GARDEN GROVE CA 92843 d <br />INSURER D: <br />INSURER E: <br />ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR E POLICY PERIOD INDICATED. NOTWITHSTANDING <br />THE POLICES TI <br />ANY REOUIREMENT. 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. AGGREGATELIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTA <br />N= <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />laMtY <br />POUeYErPwATrox <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILIT' <br />CLAIMS MAD OCCUR <br />5763733-00 <br />01124/07 <br />01124/08 <br />EACH OCCURRENCE <br />$ 11000, <br />PPfN TO ) <br />8 100,000 <br />MID. EXP (P.iy orar pawl) <br />y 2,SQD <br />PERSONAL 6 ADV INJURY <br />E 1,000,000 <br />GENERALAGGREGATE <br />$ 3,000.000 <br />GENL AGGREGATE UNIT APPLIES PET <br />X POLICY PR6 LOC <br />PRODUCTS-COMPIOP AGG. <br />E 3.000,000 <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />COMBINED SINGLE LIMIT <br />(Ea accxkM) <br />$ <br />BODILY INJURY <br />(Par Pa ) <br />S <br />BODILY INJURY <br />(Pa �qq� <br />$ <br />PROPERTY DAMAGE <br />$ <br />GARAGE LIABILITY <br />ANY AUTO <br />AUTO ONLY -EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />AUTO ONLY' AGG <br />$ <br />S <br />EXCESS i UMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />DEDUCTIBLE <br />RETENTION E <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />E <br />S <br />$ <br />11S <br />COMPENSATION AND <br />EMPLOYERS LIABILITY <br />EMPLOYERS' <br />11NY PROPIIETMWMINEPR%ECUINE <br />ofRLmaxcwoaw <br />rY..a.Paa..iM.r <br />seccyriProYAoals u.lew <br />M STAT <br />ToaYUArs <br />I <br />— <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />E.L. DISEASE -POLICY UMR <br />$ <br />OTHER: <br />DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />The City of Santa Ana, Its officers, employees, agents, and representatives are added as an additional Insured but only as respects the <br />operations of the named insured except that liability resulting from the additional insureds sole negligence. <br />Additional Insured Endorsement is Effective: 02/27/07 <br />CGOTICICATP HOLDER CANCPI 1 ATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 <br />DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT <br />The City of Santa Ana, I[S officers, <br />tY <br />FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br />employees, agents and representatives. <br />INSURER, ITS AGENTS OR REPRESENTATIVES. <br />P.O. Box 1988 M-23 <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />Cd-/ 7� <br />Attention: <br />Jeffrey E. Frick, CEO <br />ACORD 25 (2001108) Certificate # 53663 © ACORD CORPORATION 1988 <br />