RAMIREZ, SANDRA PATRICIA - 2011 - Laserfiche WebLink

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DATE (MM/DD/YYYY) ACOR�TM CERTIFICATE OF LIABILITY INSURANCE 09/20/2012 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the arms and conditions of the policy, certain policies may require an endoreemeni A statement on this ceRlflcate does not confer rights to th certificate holder in Ileu of such endorsements . RODUCER // K8K Insurance Group, Inc. N � � // � ` fO L CONTACT NAME: Ma35 Merchandising PHONE (A/C, No. Extl: 1- BOO -506 -4856 FAX (A/C, No): 1- 260 -059 -5590 '1712 Magnavox Way Fort Wa ne IN 46804 E -MAIL ADDRESS: infO�fitneSSinSUranCe- kk.com INSU REO 2000064123 CP# 3309 INSU RER(s) AFFORDING COVERAGE NAIC # Sandra p ramirez INSURER A: NatlOnWlde Mutual Insurance Company 23767 104 Western Ave Apt #2 Buena Park, CA 90621 Member of the Sports, Leisure &Entertainment RPG INSURER B: DAMAGE TO RENTED PREMISES Ea occurrence INSURER C: INSURER D: COVERAGES CERTIFICATE NUMBER: 2000070347 REVISION NUMBER: 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. INS R LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DO/YY) POLICY EXP (MMIDD/YY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 6BRPG0000005142000 06/05/12 12:01 AM 06/05/13 12:01 AM EACH OCCURRENCE $1,00p,o00 DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS- MADE�OCCUR MED EXP (Any one person) $1 O�OQO PERSONAL 8 ADV INJURY $1 000 000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER_ PRODUCTS- COMP /OP AGG $1,000,000 POLICY OPROJECT OLOG PROFESSIONAL LIABILITY $1,000,000 LEGAL LIAR TO PARTICIPANTS $1 ,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee Accident BODILY INJURY (Per person) ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per ercitlent) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per ac�itlent X No[ provitletl while in Hawaii UMBRELLA LIAB OCGUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR /PARTNER/ EXECUTIVE OFFICER /MEMBER EXCLUDED N / A EL EACH ACCIDENT EL DISEASE — EA EMPLOYEE (Mandatory In NH) E.L. DISEASE — POLICY LIMIT 11 yes, tlesUba under DESCRIPTION OF OPERATIONS below MEDICAL PAYMENTS FOR PRIMARY MEDICAL PARTICIPANTS EXCESS MEDICAL D RIP I N P RATI N / L CATION / VEHI LE (Altecb A RD 101, Atltl tlonel emarka eheau a, IT more apace Ia requlretl) Certi£ed Instructor of: ZUMBA® The certificate holder is added as an additional insured, but only with respect to the liability arising out of the operations of the insured named above. "Effective 09/19/12 - 06/05/13" CERTIFICATE HOLDER CANCELLATION CI[y of Santa Ana, ItS OmCerS, employees, agents, representatives &volunteers SHOULD ANY OF TYIE ABOVE DESCRIBED POLICIES 8E GANGELLED 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 AUTHORIZED REPRESENTATNE S �'� .�t�� _ S� o t�Q� Bey � ��S)'` ��G�ty P Coverage is only extended to U.S. events and activities. tea'(` " NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and)YS�u�ations of the State of Texas. ACORD 25 (20'10/05) ©1988 -20'10 ACORD CORPORATION. Ail rights reserved. The ACORD name and logo are registered marks of ACORD