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RDTM 05/ 25 CERTIFICATE OF LIABILITY INSURANCE DATE (25//201 12011Yn HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to th arms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the """"--- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE CONTACT NAME: Mass Merchandising K&K Insurance Group, Inc. NS LTR PHONE (A/C, No. Es,t): 1-800-506-4856 IFAX (A/C, NO): 1-260-459-5590 1712 Magnavox Way SU BR WVD E-MAIL ADDRESS: info(ofitnessinsurance-kk.COm Fort Wayne IN 46804 N-2011-089 POLICY EXP MM/DD/YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR PRODUCER CUSTOMER ID #: 10193885 INSURED CP# 831 INSURER(S) AFFORDING COVERAGE NAIC # Maria L Madrigal EACH OCCURRENCE $1,000,000 INSURER A: Nationwide Mutual Insurance Company 23787 070 S Bradford PI., #C PERSONAL B ADV INJURY $1,000,000 INSURER B: Santa Ana, CA 92707 Member of the Sports, Leisure 8, Entertainment RPG INSURER C: GENERAL AGGREGATE $3,000,000 INSURER D: NI HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NS LTR TYPE OF INSURANCE ADDL INSR SU BR WVD POLICY NUMBER POLICY EFF MM/Dp POLICY EXP MM/DD/YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR 6BRPG0000004934600 02/03/11 3:44 AM EDT 02/03/12 12:01 AM EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES(Ee oceurrence $500,000 MED EXP (Any one parson) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY =PROJECT=LOC PRODUCTS-COMP/OP AGG $1.000,000 PROFESSIONAL LIABILITY $1000,000 LEGAL LIAB TO PARTICIPANTS $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea AccltleM AUTO BODILY INJURY (Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) ]ANY SCHEDULED AUTOSPROPERTY DAMAGE PeraccitlantHIREDAUTOS NON -OWNED AUTOS Nat provitle0 while in Hawaii UMBRELLA LIAR OCCUR ter. AS 1. O ORM EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DEDUCTIBLE 1-1 RETENTION WORKERS COMPENSATION— AND ANYPROPRETOWPARTLIABILITY ER/ Y� EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA A ` oin L�]❑L l ` E [y Ayy ttorn WC STATU- OTH- TORY LIMITSER E. L. EACH ACCIDENT E.L. DISEASE — EA EMPLOYEE E.L. DISEASE —POLICY LIMIT If yes, describeuntlar DESCRIPTION OF OPERATIONS below MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach AC=RD 101, Additional Remertcs Schedule, if Moro Space Is required) Certified Instructor of: ZUMBA(D The certificate holder is listed as an additional insured, but only with respect to the liability arising out of the operations of the insured named above. " Void and re lace Certificate #W00077621 "' City of Santa Ana its officers, employees, agents and representatives SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 20 Civic Center Plaza BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. Owner/Manager/Lessor of Premises 1--TH--E- REPRESENTATIVE Coverage is only extended to U.S. events and activities. " NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. ACORD 25 (2009/09) O= 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD