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I DATE (MWDDIYYYY) <br />ACORD TMCERTIFICATE OF LIABILITY INSURANCE i 10/1012008 <br />. <br />PRODUCER Phone (6-00)345-6075 r�,,. (Hsal�ls.nez2 THIS CERTIFICATE IS ISSUED 145 A MATTER OF INFORMATION <br />FITNESS AND WELLNESS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />380 STEVENS AVENUE, SUITE 206ALTER TUF <br />SOLANA BEACH CA 92075 <br />i"�Lex);I& —('�/q1 <br />J 1 <br />INSURED VV <br />JORGE A. HIGUERA <br />DBA KARATE DO OKINAWA <br />1925 E LA VETA AVE SPC# 26 <br />ORANGE CA 92856 <br />i <br />INSURERS AFFORDING COVERAGE <br />Agency LlC#' 03776'1' <br />37764 5_I__., ---- -- - - - — <br />INSURER A. Philadelphia Indemnity Insurance Company <br />IINSURER B: --- <br />INSURER C. --- <br />INSURER D' <br />Ib1 Stt IRFR F _ <br />–F <br />NAIC # <br />COVERAGES <br />NAMED ABOVE FOR <br />THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED <br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT <br />TO WHICH THIS CERTIFICATE <br />TERMS. EXCLUSIONS <br />MAY BE ISSUED OR <br />AND CONDITIONS OF SUCH <br />ANY REQUIREMENT. <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE <br />MAY PERTAIN, <br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />POLICIES. AGGREGATE <br />POLKY EFFECTNET <br />POLICY EXPIRAnON <br />LIMBS <br />INSR4DD'L POLICY NUMBER <br />LTR I TYPEOFINSURANCE DATE MWD <br />DATE MWD <br />10111109 <br />EACH OCCURRENCE Is 1,000,000 <br />GENERAL LIABILITY PHPK284105 1 10111108 <br />DAMAGE TO RENTED $ 100,000 <br />xCOMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occure ) - <br />MED EXP (Any one person) <br />$ 21500 <br />— CLAIMS MADE X I OCCUR <br />PERSONAL & ADV INJURY <br />$� 1,000.000 <br />– <br />A — <br />..� Ij <br />GENE RAL AGGREGATE <br />$ 3,000,000 <br />PRODUCTS-GOMPlOP AGG. <br />$ 3,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />— PRO- LOCA <br />X POLICY JECT <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />ANY AUTO <br />� <br />BODILY INJURY <br />1 ALL OWNED AU705 <br />(Per person! S <br />1 SCHEDULED AUTOS <br />HIRED AUTOS <br />BODILY INJURY $ <br />(Per accident) <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE $ <br />-- --- <br />(Peraccident) <br />- AUTO ONLY •, EA ACCIDENT $ <br />GARAGE LIABILITY <br />OTHER THAN EA ACC S .. <br />ANY AUTO <br />AUTO ONLY AGG $ <br />EACH OCCURRENCE $ <br />EXCESS I UMBRELLA LIABILITY <br />$ <br />OCCUR r- CLAIMS MADE <br />AGGREGATE -_—__ -, <br />DEDUCTIBLE <br />--- <br />$ <br />RETENTION A-- <br />wcsTATu OTHER <br />TDRY LIA11T5 <br />.WORKERS COMPENSATION AND <br />- <br />- <br />EMPLOYERS, LIABILITY <br />E L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNERIEXECUrNE <br />/ <br />E L. D18EASE-F.A EMPLOYEE S <br />OFFICERIMEMBER EXCLUDED? <br />.� .. <br />E.L. DISEASE•POLICY LIMIT $ <br />If yes, d.wrl wd•i <br />- --' <br />SPECIAL PROVISIONS b.1— <br />OTHER y Atbr <br />ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS <br />insured but only as respects the operations of the named insured <br />It is understood and agreed that the following entity is added as an additional <br />except that liability resulting from the additional insureds sole negligence. <br />CERTIFICATE HOLDER CANCELLATION <br />P <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS <br />WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO <br />DO SO SHALL IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br />AGENTS OR REPRESENTATIVES. <br />City of Santa Ana <br />888 W. Santa Ana Blvd <br />2nd floor <br />Santa Ana, CA 92701 <br />Attention: <br />ACORD 25 (2001108) Certificate # 81787 <br />000� C." � 7� <br />ey E. Frick, CEO <br />C ACORD CORPORATION 1988 <br />