|
•
<br />�DATE I-HNIaNYYYYI
<br />1'1N29i2D12
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFosIMATON ONLY AND OONFER s NO R10HT^a UPON THE CERTIFICATE HOLDER, THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENDOR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
<br />THIS CERTIFICATE. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORt2ED
<br />REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE
<br />HOLDER
<br />IMPdRTANT, If the certificate holder is an A00171ONAL INSURED, the NDpcy{les) must be endorsed. If SUBROQATION IS WAIVED, Subject to the
<br />terms and conditions of the policy, certain policies may, require an Endorsement. A statement on this oartlfldaw dee$ not, confer rights to the
<br />ceriHioato ltolderinaieu of suoh:Bttdorsamevt S'-_
<br />'�
<br />,�,,,,,,
<br />PR6@vCati
<br />-o TAG�'f`"" .Mass Ntereh'UIid9.Ewridoy
<br />NAME .rent_ _,.,......
<br />MSIC Insuranae QnNup,:UC.�'
<br />1712 Magnevax Way
<br />Fort Wayne Indiana 46,804
<br />._......u-
<br />pHoe¢ $e$9ND RC4 FaX 1AIo, Nal :280.4''9-6998
<br />cr>1AItn axe: --------- -•
<br />DaESS1 InfDafibressihsuraoce-kk.tern _
<br />INSURaRTS)AF€CROP16 COVE RA U5
<br />NAIC9 _
<br />'.INsuhElz
<br />A:-iNatioowLie FAGi4lal tnsuranseCDm mh...
<br />E3TgT
<br />IalsueED.
<br />Nanay Lopes.
<br />.
<br />NsuxaA D•
<br />9,116 Golden West Ave
<br />Re
<br />AneOber CA 92704
<br />A Membero&the Sports Leisure ENerteirrmenl:F�fYp`
<br />I
<br />iNsuRER €
<br />COVERAGES CERTIFICATE NUMBER; Nf002427b1
<br />REVISION NUMSFR
<br />THIS IS,TO CERTIFY THAT THE BOLICIESbF NSURANCc LISTED IREI OW HAVE BEEN ISSUED TO THE fNSJHED NgME0 AB''579 R THE POILOY'PERIOD INDIC?ATCP7
<br />NOTIMTHSTANDINO ANY REOUIREIMIENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER 00CUMENT WITN RCSPECQ' TO WHICH THIN CERTIROATE MAY BE
<br />ISSUED OR MAY YFRTAIk THC INSURANCE AFFORDED BY THE FOLIOle6 DESCRIBED HEREIN IS.SLELMOT TO ALL THE TERMS, SXCLUSIONS AND CONDITIONS OF
<br />so .I IES, LIMITS SHOWN'MAY HAVE BEEN RE0UCE0 SY PAID: CLAIMS
<br />NCR ADDL sues P_CdICY FPB PoLloyFXP � �
<br />TYPE OF INSURANCE 'OLcy HUMPER UNIONLTR INSR ME MJDDM" MMIOGYX
<br />A
<br />aEKERALLiABILITY`
<br />X
<br />COMMERCIAL GFNPRfit LIABILITYd;ftl
<br />t;
<br />SCRRFG004C{705tA2Y700
<br />14V25i7412
<br />FNI EDT
<br />10V25Iy)15
<br />12:01 AM
<br />LAGF CCCURR. E
<br />$1000,00D.
<br />OAmAae TO REN-181)
<br />RrtFhi15E5r a,ymneM.--
<br />—�TjQ(t,pDO
<br />Y;l AIMS.h+ADE OCCUR
<br />1{MEOFXP(AnX s'e parson'
<br />�» _
<br />S10>0Q0
<br />IR RSONALaADd UA,JRN
<br />S1,OOO.t)OO
<br />�$6
<br />•.�•• •..,.
<br />ffGENr IiALAPCAKWIC
<br />DDQ OQ4'
<br />uuN'L TSC. NFGATE LNoT APPLIES PSR:
<br />POLICY ��PAOJE.T 1-71.0C
<br />••••••""^
<br />AUY)MOBLELIA9iUTY
<br />....
<br />{ CYf7'IT .COMROPA00
<br />_
<br />PKt?F Oh AL t AEIHTY
<br />4 Oa LINO 0PIWTICTA?1Tfi
<br />1 l NI1 u:0 NIL L hT •••••
<br />$1 aarrQ
<br />$1,00
<br />1,ilUtf,QO
<br />IbOr Y AI oaY
<br />ANYA;)T7
<br />{
<br />I[
<br />AL!. iJWNaG Ad'AJ I4CH _CKILED
<br />L GS
<br />ION 61M1Na
<br />HIR80AJrLS Uinu
<br />'. M'II Pre Jed wnllainHayYal
<br />1
<br />1
<br />F auale )
<br />IWW P) U31`F fdGd'd2Mf
<br />R aERI: [}0Rd1 Emm--'
<br />'
<br />:. UM115ttELLA LIAR OCCUl
<br />AQH CGUIRRiuCE.
<br />�r
<br />OFF TT
<br />.
<br />8$Ce83-LIA6. .�vs RM$r±M08
<br />_
<br />CEt} R=iENT`ONmm
<br />RNpRS ObtpEN5A'SON
<br />AHD EMPLOYERS LIA6141TY Y:/Q{,
<br />ADIY PROPRIpTOR sR'PARTNER/ C..A.L
<br />F
<br />1 -
<br />VI SIn d OTHER
<br />T HY..l.Ur11T¢
<br />rn,GHAWIDENT
<br />EFT"LUDED, NV.ratM1l"c Mees
<br />EXGI:UCE9T
<br />(dirt
<br />R.L. J15 A5 F,:w eH1Awyff
<br />—.--
<br />$.i, DIBa'Po3F-4KSWC.`t LIMRF
<br />PINEriaR 1 91aAL..
<br />E(GewSMFoiMt
<br />—. _..._..-
<br />j
<br />IMSRdatarybtHNj
<br />O XKga9bCMHppnadc
<br />y,Esclap IpN OF CPERANON's below
<br />IIdED LPAYMPNTS:FGA PARTICIPANTS
<br />-
<br />TION r CCA_ III
<br />(=M
<br />A�
<br />.. n, -A, ons gmdiY.y BGbedute.
<br />piaxe tp0. W
<br />tegpre: —
<br />.R .
<br />Cartif
<br />nt Instructor of., 2UMBAO
<br />Abuse;
<br />Molostatttrm, Harassment o, Sexual CondutIt'Dafenaa
<br />cost Relmbursement- 51
<br />QD,09D imit_
<br />E _ -' HOULI) ANY OF THE ABOVE NECPOLICIES BEED 3E
<br />FORE -FcECOovbrsgs THE EXPIRATION DATE
<br />THEREOTI, NOTICE WILL BE DELIVERED ACLGRCAACIF
<br />K' TH THE POLfiy PROVi51pa6
<br />kUTNp}Rti RE.RESENTATNE
<br />Coverage IN only estanded to U.S. events and actluSUes
<br />'" NOTICE TO TEXA JNSURCDS The Insurer for the purchasing group may net be subject to all the InsuraNts laws and mgulations of the. -State of Texas
<br />ACORD 25 (201010,5). ThOAGORC name And logo areregisteredmarks of ACORD to 199a-2010 ACORD CORPORATION. All rights reserved.
<br />APPROVED ^AS TO FORM
<br />11
<br />LISA E SToRCK
<br />Asslstant City Attorney f
<br />
|