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1`17- <br />- .gnu CERTIFICATE OF LIABILITY INSURANCE 1Dzsrz9D7 <br />-'� - F` Ya ! ^. I 395-8076 m (ASS, 519 sen THIS CERTIFICATE 19 ISSUED AS A MATTER OF <br />I FITNESS AND WELLNESS INFORMATION <br />I lu STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC{ TE <br />f '•L _.'d•.A BEACH CA 92D75 <br />INSURERS AFFORDING COVERAGE NA1C # <br />INSURER A: Philadelphia Indemnity Insurance Company <br />POLICY NUMBER <br />UORGEA. HIGUERA INSURER 6' <br />1011-r.IMAAT M LIMITS <br />_. <br />I <br />I DBA KARATE DO OKINAWA <br />INSURER C. __ <br />1925 E LA VETA AVE SPC# 26 <br />_ <br />C c.ANCE CA 92866 INSURER D: <br />i PHPK215316 <br />INSURER E: <br />_ <br />_IEIED 6E.OW HAVE BEEN ISSJED TC T,E INSURED NAMED ABOFOA THE POLICYFER:1D INDICATED. NCT. I.STANDINC <br />'- I 6F L'.?,ITY <br />=E0 IREMENT, TERM OR CONDITION OF ANV CONTRG.T OR OTHEP DOIUMENT WITVI REFECT TO WHICH TH.S CEP-IFICATE MA1 BE ISSUED GF <br />'.NSL'RANCF A=FOPOLO BY THE PO:ICICS DESCRIBED HEREIN IS SUBJECT A: ALLTIIC TERMS, EXCLUSIONS AND •:GNDIP!N:5 OF SUCH. <br />W1MLE la nErvrEe <br />1 PPFNISr<I%. v.....n: e1 1 100,000 <br />=- =S A: SgR `IATF I IMITS SHOM MAY HAVE BEEN REDUCED B} PAID CLAMS <br />------15UMNW <br />- <br />POLICY NUMBER <br />POu[Y FFKCIN[ <br />1011-r.IMAAT M LIMITS <br />WTE dawrm <br />WrF vsw <br />i PHPK215316 <br />1011V07 <br />10111106 <br />EACH LIC ]URPFN,F 1,000,000 <br />'- I 6F L'.?,ITY <br />W1MLE la nErvrEe <br />1 PPFNISr<I%. v.....n: e1 1 100,000 <br />_4M5NAOCu OCCUR <br />MED F4R yYYun!fcrunl 1 --- 2,500 <br />REVeS:xJALxare w;Lw [ 1.000,000 <br />__ <br />H <br />BCNERAL N;GRE9r.i[ 1 3,00,000 <br />+ GENT AGGREGATh LIMA APP -ICS PER <br />FR- IC- d_TEI .1F'0.IF AC„ { 3,000,000 <br />1 FF5 <br />], POLICY .I?' <br />I <br />AU-OYOBL' E LIABLLRY <br />'ODIABPIEE 5'16LE LIMIT <br />-.. .A: J <br />Ea acO]5n11 P <br />ALL CWTF-, AI I7.'i <br />5(11111 I INJ,IR1 <br />cCHEDULEDAUTOL <br />ILPi )P'Sn.,l 4 <br />I ryIPED AJ -OS <br />BPA L � IHJLR` <br />__ ,LLT[$ I <br />1Pxl x: mend <br />PPOPETB• Luu6E <br />' <br />1Px aomelrl <br />GARAGE UABILRY <br />ALIT)JN.r. EP,i.G]ICENT 1 <br />Or HER PIA. CAACC 1 <br />ANYA_1O <br />AU OONLY �;, 1 <br />ES^55'VYe4EW LIABLLRY <br />EArR h[CURRENCE '1 <br />.... L✓ J:AW MADE <br />JACU <br />-ATE <br />1 <br />DEDUCTIBLE <br />L <br />RETEN-ION I <br />___....� <br />q <br />pt PE'<SAn0N At10 <br />we srnru arlcr. <br />TORY LIW'S <br />'E2CIfFCL'TRE <br />EA.=HACCHD6NT F <br />. c.Io[ovD,iE/Se-EA <br />EMPLOYEE i <br />. <br />F, DISEASE-POLIC'I LYT I <br />CESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEX ADDE64111('ENDORSEMENTl SPECIAL PROVISIONS <br />---de•s`ood and agreed that the following entity is added as an additional insured but only as respects the operations of the named it is <br />-' -� - .i„y resulting from the additional insureds sole negligence. This Policy is Primary and Non-contributory. <br />.... -: ^oca `i-su red Endorsement is Effective: 10111/07 SEE ATTACHED ADDITIONAL INSURED ENDORSEMENT CG 20 2611 15 <br />a <br />'B AgePte, Officers, Volunteers, Employees & <br />?eo-eaentativae <br />888 W. Santa Ana Blvd Suite 200 <br />IC Boz 1888 M-23 <br />Certificate# <br />SHOULD ANY CF iNE PROVE LESCPoB`_D POLICIES BE 'AIb:CLLEC• DCr )RE ISE <br />F:PIRATIrA -ATF TIFPr0F 711F ,F,0.74: PI.,H f VYIII FMFA'::iP T" WII 111 <br />LAYS WRITTEN -X)I ICE TJ IME -ERT IF]-, TE r LD EP LANE[ r0 INE I :=1 B�,T <br />FAILJRE TO DO !O SHA_L IMPOoE N JOEL 1:PTI JN CP LIAB.LIT, Jr V IY Le< IN CL THE <br />INSURED ITSACCNTSORRCPRCSCNTATIVCS <br />Acr,- : /�i�+eMf <br />rey E. Frick, CEO <br />®ACORD CORPORATION 1988 <br />ured <br />