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A CORD DATE (MMVDD/YYYY) <br />f.1. CERTIFICATE OF LIABILITY INSURANCE 1 20/1012008 <br />PRODUCER PhoneT(BO0)395-ems Fa.. (858151"B22 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />FITNESS AND WELLNESS 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 92075 E Al TER THE ) <br />FRAGF AFFORDED BY THE POLICI <br />(/ IAAgency Llc#'03P6 <br />INSURERS AFFORDING COVERAGE <br />45 NAC # <br />Y� INSURER A. Philadelphia Indemnity Insolence Company <br />INSURED _ T <br />JORGE A. HIGUERA IINSURERB'.— <br />DBA KARATE DO OKINAWA INSURER C. <br />1925 E LA VETA AVE SPC# 26 INSURER D' - <br />ORANGE CA 92866 --— <br />COVERAGES <br />NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED <br />WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT <br />IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS <br />AND CONDITIONS OF SUCH <br />DO SO SHALL IMPOSE NOOSLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN <br />AGENTS OR REPRESENTATIVES. <br />88 W. Santa Ana Blvd <br />POLICIES. AGGREGATELIMDS SHOWN MAY HAVE BEEN REDUCED BY PAID GLAIMS. <br />AUTHORIZED REPRESENTATIVE <br />el zca <br />_ <br />POLICYEFFECTNE� POLICTE%PIRATI <br />LIMBS <br />E OF INSURANCE POLICY NUMBER DATEMM, GATE MWDDAL <br />1,000,000 <br />PHPK284105 20111108 10/21/09 <br />EACH OCCURRENCE$ <br />LIABILITY <br />DAMAGE TO RENTED $100000 <br />OMMERCIAL GENERAL LIABILITY <br />PREMISES(E. ouurence) <br />CLAIMS MAGOCCUR <br />MEO EXP (Any one pe$PERSONALSADVINJURY <br />s- <br />-GENERALAGGREGATE$3,000,000 <br />AGG. $ <br />3,000,000 <br />GGREGATE LIMIT APPLIES PERPRODUCTS-GOMPIOP <br />PRO-OLICY JEOOBILE <br />LIABILITY <br />COMBINEDSINGLE LIMIT <br />$NV <br />accitlNJULL <br />AUTO <br />�Ea <br />BODILY INJURY <br />5"CESS/UMBRE�UABILITY <br />OWNED AUTOS <br />(Perperson)SCHEDULED <br />AUTOS <br />HIRED AUTOS <br />BODILY INJURY$(Per <br />accdent)NON-OW <br />NED AUTOS <br />PROPERTYDAMAGE $ <br />--(Per <br />accGE <br />UABILITY <br />AUTO ONLY - EA ACCIDENTANY <br />OTHER THAN EAACCAUTO <br />AUTO <br />ONLY AGGSSIUMBRELLAUABILITY <br />EACH OCCURRENCE <br />$ <br />OCCUR CLAIMS MADE <br />AGGREGATE <br />_ <br />- <br />DEDUCTIBLE <br />- — <br />$ <br />RETENTION $ <br />- <br />WCSTATI} OTHER <br />TDRY L <br />WORKERS COMPENSATION ANO <br />E L EACH ACCIDENT $ <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETONPARTNEWE%ECWNE <br />/ <br />E L. DISEASE -EA EMPLOYEE $ <br />OFFKERIMEMBER EXCLUDED? <br />E. L. DISEASE -POLICY LIMIT $ <br />If yes, descree undo <br />I_ <br />SPECWL PROVISIONS below <br />OTHER <br />y Ath <br />DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ <br />SPECIAL PROVISIONS <br />and agreed that the following entity is added as an additional insured but only as respects the operations of the named insured <br />It is understood <br />except that liability resulting from the additional insureds sole negligence. <br />CANCELLATION <br />CERTIFICATE HOLDER <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS <br />EXPIRATION <br />WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO <br />DO SO SHALL IMPOSE NOOSLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br />i of Santa Ana <br />City <br />AGENTS OR REPRESENTATIVES. <br />88 W. Santa Ana Blvd <br />AUTHORIZED REPRESENTATIVE <br />el zca <br />nd floor <br />[Attention: <br />anta Ana, CA 92701 <br />Jeffrey E. Frick, CEO <br />cn ACORD CORPORATION 1988 <br />ACORD 25 (2001108)—enmcate 9 o I r o, <br />