CHAVIRA, YOLEINIS - 2012 - Laserfiche WebLink

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R�TM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/rvrY) 1 1 /05/20 t 2 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 ceRlfleate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the arms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer risthts to th :8.K Insurance Group, Inc. 712 Magnavox Way ort Wayne IN 46804 ISURED oleinis chavira IBA: Yoli '126 W st Gertrude PI :ante Ana, CA 92707 r_F ADDRESS: infOQfitnes5insurance - kk.COm INSU RERI S) AFFORDING COVERAGE !R A: Nationwide Mutual Insurance Coml: D: 1- 26069 -5690 NAIC K 23787 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 O UCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4ttn: Cannes Acosta ACCORDANCE WITH THE POLICY PROVISIONS. 1825 W Civic Center AUTHORIZED REPRESENTATNE R TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YVI (MM/DD/YY) A GENERAL LIABILITY 6BRPG000OOOSt42000 '10/31/t2 '10/3'1 /13 EACH OCCURRENCE $t 000,000 X COMMERCIAL GENERAL LIABILITY f 2:0'1 AM '12:0'1 AM DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS -MADE � OCCUR MED EXP (Any one person) $'10,000 PERSONALS ADV INJURY $t 000 000 GENERAL AGGREGATE $rj 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $� 000,000 POLICY OPROJECT OLOC PROFESSIONAL LIABILITY $1,000,000 LEGAL LIAR TO PARTICIPANTS $'1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Ancitlen[ BODILY INJURY (Per person) ANY AUTO ALL OWNED AUTOS �UTOSULED BODILY INJURY <Per ancitlanry HIRED AUTOS NON -OWNED PROPERTY DAMAGE UTOS Par accitlent X No[ provitletl while in Hawaii UMBRELLA LIAB OCCUR EACH OCCURRENCE - EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY V / N TORY LIMITS ER ANV PROPRIETOR /PARTNER / ^I E.L. EACH ACCIDENT I EXECUTIVE OFFICER/MEMBER � —J N / A E.L. DISEASE - EA EMPLOYEE EXCLUDED? (Mandatory In NH) If yes, tlesrnbe untler DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT MEDICAL PAYMENTS FOR PRIMARY MEDICAL PARTICIPANTS EXCESS MEDICAL E RIPTI N F PERATI N / L ATI N / V H (Attach A RD 101, Atltltt oral ertlsrka ehadule, If more space Is required) Certified Instructor of: Aerobics, Children's fitness programs, Dance, Exercise, ZUMBA® The Certificate Holder is added as an Additional Insured but only with respect to the liability arising out of the operations of the Named Insured above. amity of Santa Ana, Parks, Recreation and Community Services Agency, it's SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED )f£CerS, agents and employees BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4ttn: Cannes Acosta ACCORDANCE WITH THE POLICY PROVISIONS. 1825 W Civic Center AUTHORIZED REPRESENTATNE Santa Ana, CA 9270'1 ,t • - n / 7wner /Manager /Lessor of Premises /�"�7V71t- / /L4,`^ //H/^'t/'f! � nC T Coverage is only eMended to U.S. events and activities. AppRQV� A � S�}�v �gRCKney l( �,-1/�'j "NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and \�qSg ;y�tIOPIS`0f the State of Texas` ACORD 25 (2070/05) ©'1989 -2010 ACOI�tS�d- I�PORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD