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lV -~~C'~S - v f(~ <br />ACORD CERTIFICATE OF LIABILITY INSURANCE i ~ATo~nsioo WY' <br />TM <br />PRODUCER F'hale: (800) 395.8075 Fax: (858) 519-0822 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 bOES NOT AMEND, EXTEND OR <br />SOLANA BEACH CA 92075 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE C NAIC # <br />_ __ __ Agency Lich: 0377845 I <br />~ <br />INSURED INSURER A: Philadelphia Indemnity Insurance <br />~~~ <br />MARTIN TORRES ` INSURER e: <br />DBA KARATE DO KIAI INSURER C: <br />12692 RANCHERO WAY - - -- <br />GARDEN GROVE CA 92843 INSURER D: _ <br /> INSURER E. <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FDR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />btAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. 4GGREGATELIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. <br />T <br />IN$R ADD TYPE OF INSURANCE POLK:Y NUMBER vDLICY EffECTrvE POLICY EXPIRATION LIMITS <br />LTR INSR DATE MMlDDIYY DATE MMIDD <br /> GENERAL LIABILITY PHPK284105 01l2b/09 01/24/10 EACH OCCURRENCE $ 1,000,000 <br /> <br />X COMMERCIAL GENERAL LIA&LITY <br />I DAMAGE 10 RENTED <br />PREMISES Ea otturena) <br />$ 1Q0~00~ <br /> CLAIMS MPDE ~ OCCUR MED. EXP (Any one person) $ 2,500 <br />/~ . I PERSONALSAOVINJURY $ 1,000,000 <br /> GENERALAGGREGATE $ 3,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER. I PRODUCTS-COMPfOP AGG $ 3,000,000 <br /> X POLICY ~ JECT LOC <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO I IEa aCCdBnI) $ <br /> ALL OWNED AUTOS ~ BODILY INJURY <br />P <br />E <br /> SCHEDULED AUTOS ( <br />er person) <br />__ <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per BCCWeM) $ <br /> ~~ <br /> F~ PROPERTY DAMAGE <br /> ~ <br />(Per accident) $ <br /> GAR AGE LIA&LRY n <br />~r~i y AUTO ONLY - EA ACCIDENT $ <br />_ <br />^ <br /> ANY AUTD QQgO `I <br />Y OTHER THAN EA ACC _ <br />$ _ „ _ <br /> ~ <br />I <br />_ AUTO ONLY AGG $ <br /> EXCESS /UMBRELLA LIABILITY ~Lt ttOtOC ~ EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE a <br />aQ1, C,1tY AGGREGATE $ _., <br /> <br /> . . <br /> S <br /> DEDUCTIBLE <br /> RETENTION E S <br /> <br />WORKERS COMPENSATION AND <br />i W C $TATLL OTHER <br />.TORY OMITS <br /> <br />___.._ <br /> EMPLOYERS' LIABILITY <br />E E.L. EACH ACCIDENT $ _ - ` <br /> ANY PROPRIETORfPARTNERI <br />%ECUTrvE <br />OFFICERIMEMBER EXCLUDEDT • E.L. DISEASE-EA EMPLOYEE $ <br /> Myn, e.acriLwnh, <br />SPECIAL PROVISfpNS Mlow E.L. DISEASE•POLICY UAMT $ H <br />~ OTHER: '•" <br /> `TT <br /> nT <br /> c~ <br />DESCRIPTION OF OPERATIONS/LOCATIONSlVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTI5PECIAL PROVISIONS <br />'•I <br />SEE SUPPLEMENTAL CERTIFICATE INFORMATION <br />.~ <br />.7 <br />~.~ <br />CERTIFICATE HOLDER GANGtLLJ><I IVN - " <br /> SHOULD ANY OF THE ABOVE DESCRIBED POVCIES BE CANCELLED BEFORE THE <br /> EJ(PIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 70 PAYS <br /> WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 7p THE LEFT. BUT FAILURE <br />The City of Santa Ana, its officers, TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, <br />employees, agents and volunteers IT'S AGENTS OR REPRESENTATIVES. <br />20 Civic Center Plaza <br />Santa Ana CA 92701 AUTHORIZED REPRESENTATNE <br />~~~~~ ~ ~~ <br />Attention: `' <br />Jefffey E. Frick, CEO <br />ACORD 25 (2001!08) c:erllncate ~ ti rasa UAC:UKU (:V KYVKwI IVN latiD <br />1..~ ` t <br />