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AMOR CERTIFICATE OF LIABILITY INSURANCE°AEMWDDNYYY)G <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />04/22/2013 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polioy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such andorsament s . <br />PRODUCER <br />CONT <br />NAMEACT Mass Merchandising Underwriting <br />Insurance Group, Inc' <br />PHONE: <br />C No. Eat: 1-800-506-4856 FAX:(A) No): 1.260.459.5590 <br />171 Magnavo <br />1712 Magnavox Way <br />EMAIL <br />fltnseslnsurance-kk.com <br />ADDRESS: info@fltnessinsurance-kk.com <br />Fon Wayne IN 46804 <br />INSUREREN AFFORDING COVERAGE NAIC 9 <br />INsuRTRA: Nationwido Mutual Insurance Company 23787 <br />INSURED <br />INSURER a: <br />Laverne Davis <br />INSURER C: <br />2221 e. Lowell at. <br />INaURRR D: <br />Santa Ana, CA 92707 <br />INSURER B: <br />A Member of the Sports, Leisure & Entertainment RPG <br />INSURER F: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUER <br />MD <br />POLICY NUMBER <br />POLICYEFF <br />MAIIDDIYY <br />POLICYEXP <br />MMIODIYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />X <br />6BRPG00000053.59200 <br />08/08/2013 <br />12:01 AM ED <br />06/08/2014 <br />12:01 AM <br />EACH OCCURRENCE $1,000,000 <br />DAMAGE TO RENTED $300,000 <br />CLAIMS -MADE <br />PREMISES Ea occurrence <br />MED E%P (Any one parson) $5,000 <br />PERSONAL&ACV INJURY $1,000,0BC <br />GENERALAGGREGATE 5,000,00C <br />GEN'LAGGREGATE UMITAPPUES PER', <br />POLICY —]PROJECT [7]LOC <br />PRODUCTS-COMP/OPAGG ,1000,00 <br />PROFESSIONAL LIABILITY $1,000,00 <br />LEGAL UAB 10 PARTICIPANTS $1,000,00 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea Accident <br />ANY AUTO <br />ALL OWNED AUTOSSCHEDULED <br />AUTOS <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />HIAUTOS NON -OWNED <br />RED <br />IPar <br />PROPERTY DAMAGE <br />accident <br />Not provided while In Hewell <br />UMBRELLA LAB OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAS CLAIMS -MAPF <br />AGGREGATE <br />DED F–IRETENTION <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />ANY PROPRIETORSHIP/PARTNER/ a <br />EXECUTIVE OFFICER/MEMnER <br />EXCLUDED? <br />{Mandatary In NH) <br />N / A <br />WC STATU-OTHER <br />TORY LI MITS <br />E.L. EACH ACCIDENT <br />E.L. DISEASE — EA EMPLOYEE <br />E.L. DISEASE — POLICY LIMIT <br />If yen, deli under <br />DESCRIPTION OF OPERATIONS NeIJ <br />MEDICAL PAYMENTS FOR PARTICIPANTS <br />PRIMARY MEDICAL <br />EXCESS MEDICAL <br />1ILUbVAJVTI N Un Uliarri Vii I LOCATIONSVEHI I ErTc707 RD 101, Additlonal Remarks Schedule, if more apace 1R-77,717 <br />Non-cerlNed Instructor of: ZUMBA (R) <br />The certificate holder is added as an additional Insured, but only with res ect to the liability arising out of the Operations of the Insured named above. <br />The City of Santa Ana, It's ofAcers,agents and employees <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />1825 W. Civic Center, Attn: Carmen Acosta <br />Santa Ana, CA 92701 <br />(Owner/Lessor Of Promises) <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE <br />WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Coverage Is only extended to U.S. events and activities. <br />** 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 <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ©1988.2010 ACORD CORPORATION. All rights reserved. <br />APPROVED AS TO P«RN! <br />LISA I S'TOf2CK <br />assistant City Attorney <br />