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rNNI t I INESS AND WEL'_NESS INSURANCE (TUE)MAR 14 2005 16:24/ST. 16:22/No. 6820420052 P 2 <br />ACQRQMW <br />TM. CERTIFICATE OF LIABILITY INSURANCE <br />DaT011112O01YYYY> <br />0!!1 L200a <br />PAODUCER Ptom To mam vow. me) <br />FITNESS AND WELLNESS INSURANCE; AGENCY <br />M STEMS AVENUE, SURE M <br />THIS mwrN ICA7g is Iswo As A MATTER of twoRmATm <br />ONLY AND CONFERS NO MGNTS UPON THS QWMIFICATa <br />i+am 1m CERi1 it M 101 on, WEND <br />SOLANA StACH CA 02076 <br />INSWERS AFFORDING COVERAGE NAJC 8 <br />lid <br />WSURED j <�! 7 <br />KARATE 00 KIA1 A J! �' r <br />CIO MARTIN TOOMS IV - l%(%21 - n <br />12M RANCHERO WAY <br />G�AI%WN GROVE CA 02"ll A - A (yp - P/IV <br />INSURER A: Zu*M Amerftn Insuramm ConqmV <br />INSURER B: <br />INSURER C: — ....._._ ....._._ <br />BrsuAl R <br />INSURER E: <br />THE POLICIES`OF I"W BGLOW HAYS BEEN ISSUED O TK WWRW NAMED ABOVE FOR THE POLICY PFRW INDICA ANDING <br />ANY REOUIRCW-W. TERM OR CONNTIDN OF ANY CONTRACT OR OTHER DOCUMENT WIT" R9111PECT TO WHICH THIS CERTIFICATE MAY Bi W$UED OR <br />MAY PERTAIN THE iNSU1M10E AthONDED SY THE POLICIES DESCRIBED HEREIN W SIJs,ILLCT TO ALL THE TERNS. EXCLUStOWS ANG CONDITIONS OF SUCH <br />POLICIES WrM.0EATiLM1T6 IHDWN MAY HAVE BEEN RRMW BY PAID CLAW <br />LM rm OF 08MRAN6E POLICT Numm roum ofm"Ys �pLItY �IDAATIOM um" <br />A <br />GoNow LNUNL.ITY <br />X COMMEROAL GENERAL UMILITY <br />CLANAS MADI�E OCCUR <br />EOtA0 nv4I1 <br />0144W <br />01124W <br />Q,,QHOCQUlMW9 <br />; <br />, TOR <br />: 1oo,ow <br />MEO. Exr UYy eye pw0W) <br />PERSONAL i ADV INJURY <br />f 2,5D0 <br />S I,M,000 <br />f 1,000 DOB <br />dE4A00REGATE UMITAPPUES PER: <br />X roUCY LOC <br />GENERAL AGGREGATE <br />PRODUCTS-OOMP/OPAGO, <br />Ir 3,OOD,000 <br />Au <br />tmKISLE INBLITT <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HMCO AUTOS <br />NON -OWNED AUTOS <br />COMBINED SINGLE LIMIT <br />(fm eai *14 <br />: <br />BODILY 114URY <br />(FW Peron) <br />$ <br />: <br />BODILY INJURY <br />(P6raoddwt) <br />PROPERTY DAMAGE <br />s <br />GARM LMBAJTY <br />ANY AUTO <br />ONLY . rr Al=0QfTS <br />OTHER THM EA ACC <br />AUTO ONLY: AGO <br />f <br />U001114) UMLa11etJA LLA LITY <br />OCCUR M CLAM MADE <br />DEDUCTIBLE <br />RETENTION 7 <br />, } >'. ;V'sIII <br />EACH OCCURRENCE <br />3 <br />AGGREGATE <br />f <br />f <br />_ <br />BMmoym ' TION AND <br />AMY TWE <br />o n1e1Jl0Eor <br />r�rrolbe wNw <br />i/fCML MQNIlIOMt bMw <br />✓ <br />� <br />�Z <br />-- - <br />ITATL+ OTZ <br />WIT <br />_ <br />EL. EACH ACCmw <br />EL. DISFJIBE EA 9APL.OYEE <br />f <br />S <br />E.L. DISEASE -POLICY la11T <br />f <br />OTHER: <br />DESCRIPTOR OF OPERATIONSILOCATiONSWMCL ESfEXXCLUSIONS ADDED SY ENDORSEM iff? SPECIAL PROVISION$ <br />It to underetood and agreed that the following entky Is added as an additional insured but only as raspe¢ts the gmrndons of the nand Insured <br />except that liability resulting from the additional Insureds sole mgNgomo. <br />CERTIFICATE HOIIWR CANCELLATION <br />SHOULD ANY OF THE A0OW MOCROW POLICIES YE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL W)EAVOR TO MAIL io DAYS <br />MIRr17EN NOTICE TO THE GERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO <br />/+ ��� <br />The CN Of Sants An, Its off curs, <br />DO SO SHALL W4W NO omOATION OR LIADILFTY OF ANY KIND UPON THE INSURER, IT'S <br />onwkIoa, aawnis and rep "fs. <br />AGOM On RMiPRFSEWrATIVES. <br />P.O. BOX 1M EI-23 <br />Santa Ana CA 42702 <br />AVTNORm REPRE ATNE / <br />c1+I <br />/jo� <br />Attention: <br />rey E. POCK CEO <br />ACORD 25 (20011DB) CertMkate it $7174 0 ACORD CORPORATION 19M <br />