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received F'�� ® CERTIFICATE OF LIABILITY INSURANCE D;�;;-""" THIS 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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 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 terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SpOrte Venbrook Ins. Services PHONE CA License ODS0832 Eon 6320 Canoga AVB . 12th Flt. INSURERS AFFORDING COVERAGE NAIL g Woodland Hi11s CA 91367 INSURER A:Ph]. lacta1 hia Indem ;Lt INSURED INSURER B: Angelika M. Netaeth INsultERc: 19 Ash T=ea Lana INSORER D INSURER E =rVi R9 CA 92612 INSURERF- THIS 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 NAVE BEEN REDU CEO BY PAID CLAIMS- TV TYPEOPNSURANCE POLICY POLICY BER EFF MM/pXP LIMITS GENERAL UABIIJTY EACH OCCURRENCE $ M, 000, 000 X COMMERCIAL GENERAL LIABILITY R I g 100,000 A CLAIMS -MADE OCCUR ZM3N[191791 /2B /2012 /28/2013 MED EXP An one $ 2,500 X PrOE.—LOna1 PERSONAL B ADV INJURY $ 1,000,000 X Liability GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 3,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED S'NOLE LIM17 I t ANYAUTO BODILYINJURY(P—person) $ ANED S�HESULED AUTOS. O BOO ILY INJURY (Per acddent) $ NON -O I D HIRED AUTOS gUT03 PROPERTY DAMAGE $ S UMBRELLA LIAB OOCUR Z `. EACH OCCURRENCE $ EXCESS LIAR CLAIMSMAOE c' - +I--. AGGREGATE $ EO RETENTION M96— "✓ � i� $ WORKERS COMPENSATION - WC STATU- OTH- ANO EMPLOYB RS' UA81LrrY YIN _ _ — ANY PROPR1=9R/PARTNERIEXECUrIVE E.L. EACH ACCIDENT $ OFFICER -EMBER EXCLUDED? (M. -I.. In NH) NIA ry _ ---" ` t E.L DISEASE - EA EMPLOYE $ da If yes be Under gUT u i+�, DESCRIPTION OF OPERATIONS I-- _ EL DISEASE -POLICY LIMIT $ -TI �tii\ti l'� DESCRIPTION OF OPERATIONS / LOCATONS I VEHICLES (Attach ACORD 101. Addltlanel Rw,orics Schedule, If mora apace is req ulred) •'30 Day Notice OP Cancellation £or Non -Payment o£ Premium Carti£icate Holder is hereby added as a Hamad insured member o£ the Fitness and Wallnas3 Purchasing Group. Ce2tr:L ata Holder is named as Additional Insured as respects Genarai Liability as par policy Forms and conditions. I,NIY I.,CLLF\ I l V IY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Parks, ReCre:ation ACCORDANCE WITH THE POLICY PROVISIONS. and Community SeI V1003 Agency Donna Schultze AUTHORIZED REPRESENTATIVE 1625 W. Civic Center Santa Ana, CA 92701 Susan Patton/LIDP��— ACORD 25 (2010/05) m 4988-2040 ACORD CORPORATION. All rights reserved. INS02S,—rvlaf , Tho Arrfan ..ems oast I..n,. ern ronlcla red me rlr- — nrnMn