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K2✓v_kt -T`y rvV C TO 1" <br />I DATE (MMIDDP(YYYI <br />'ACORDT B� CERTIFICATE OF LIABILITY INSURANCE <br />AS A MATTER OF INFORMATION <br />PRODUCER 005 <br />3Rl LIE THIS CERTIFICATE IS FITNESS AND WELLNESS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />380 STEVENS AVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />SOLANA BEACH CA 92076 11111 1=1111:3111121 <br />INSURERS AFFORDING COVERAGE NAIC # <br />Agency <br />US#OD28716 <br />ANY REQUIREMENT , ANDMAY <br />MAY PERTAIN, TLC INSURANCE AFFORV6V BY THE POI ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS S%L <br />INSURED ORGE A HIGUERA <br />N' �'— <br />INSURER A: <br />INSURER 0: <br />I KARATE DO OKINAWA <br />POLICY NUMBER <br />INSURER C: <br />F--- <br />INSURER D: <br />1000 W. MACARTHUR BLVD <br />SUITE #130 <br />LTx'Irrfl <br />(INSURER <br />SANTA ANA CA 92707 <br />EOL9012327-01 <br />E: <br />COVERAGES <br />NAMED ABOVE FOR THC POLICY PERIOD INDICATED, NOTWITHSTANDING <br />THE POLICIES VF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED <br />'ERM CA CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS BE ISSUED <br />EUSIONS OP SUCH <br />ANY REQUIREMENT , ANDMAY <br />MAY PERTAIN, TLC INSURANCE AFFORV6V BY THE POI ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS S%L <br />POLICIES AGGREGATE LIMITS SI IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />(NSR <br />wOY <br />TYPE OF INSVRM'CE <br />POLICY NUMBER <br />PIX�EY E�fMfOFGTNE <br />PGIAaTCE R,ap ATpN <br />LIMITS <br />LTx'Irrfl <br />GENERAL LIABILITY <br />EOL9012327-01 <br />10/11W6 <br />10/11M6 <br />EACH oc[uRRENLE g 1.000,000 <br />IPROMIETG PENrEo s 100,000 <br />X COMMERCIAL GEN=RALIIARILITT:. <br />PREMISES IEa xounrcel <br />I EXE (Any we yvuon) E 2,560 <br />CLAIMIMI OCCUR <br />PERsorvALe ALV INJURY $ 1,000,000 <br />A <br />.NERAL AGGREGATE $ 9,000,000 <br />PRODUCTS COM P/CPAGO $ 3,000,000 <br />GEN'L AGGREGATE LIMIT APPVES PER. <br />Pi0. <br />X POLICY JECT LOC <br />pUTOMDBILE <br />LIABILITY <br />OOMGINED Ell LIMIT S <br />(Ea aaiden¶ <br />ANYAUTU <br />BODILY INJURY <br />BO(Per <br />ALL OWNED AU TOS <br />IID Nf <br />SCHEDULED AUTCS <br />HIREDAUTOS <br />BODILYINJURY S <br />rPeraecldenn <br />NON OWNED AUTOS <br />-- <br />PROPERTY DAMAGE S <br />-- <br />(Per3ECIGeM) <br />GARAGE LIABILITY <br />AUTCONLY-EAACCIDENI S <br />OTHER THAN EA ACL S <br />ANY AUTO <br />AUTO ONLY: ABU $ <br />EACH OCCURRENCE $ <br />EXCESS I UMBRELLA LIABILITY <br />- <br />IX:CUR LI CLAIMS MADE <br />iAGGREGATE <br />_f <br />S <br />DEnUCTIBLE <br />- <br />S <br />RETENIIVN S <br />\yC pTAN <br />TOPY LIMPS GTIER <br />WORKERSCOMPENSATION AND <br />E.1— EACH ACCIDENT S <br />EMPLOYERS' LIABILITY <br />'EL, VISG45E FA EMPLOYE E 5 <br />AN PRIETORTARWEEe1CBUT <br />RMCER EXCLYOEO'1 <br />DINEMR Shnnen <br />OI <br />.. IsIl <br />Et DISEASE POLICY LIMIT S <br />3 ECIALPROW&BRI <br />OTHER: <br />UESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES, <br />ONLY AS THEIR INTERESTS MAY APPEAR. <br />r -11E. 1 AThl <br />CITY OF SANTA ANA <br />PARKS, RECREATION, 8. COMMUNITY SERVICES AGENCY <br />888 W. SANTA ANA BLVD, SUITE 200 <br />PO BOX 1988 M-23 <br />SANTA ANA, CA 92702 <br />Attention: PEGGY L CALVERT <br />ANY OF THE ABOVE DESCRIBED POLICIES RL CANUELI EO BEFORE THE <br />ION DATE THEREOF, —HE ISSUING INSURER WILL MAIL YO DAYS W±nTEN <br />TO THE CERTIFICATE HOT DFR NAMED TO THE LEFT <br />711.a <br />Jeffrey E. Frick, CEO <br />n ArnoD CORPORATION 1688 <br />ACORD 25 (2001108) <br />