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A GUKUTM CERTIFICATE OF LIABILITY INSURANCE DATE "' '� "�'- ��•`• 131120IYYVV) 05/31/2013 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 CONTACTNAME: Mass March Underwriting K&K Insurance Group, Inc PHONE: 1712 Magnavox Way A/c No. Ext: 888-580-8041 FAX: (A/C, No): 260-459-5995 Fort Wayne Indiana 46804 y E-MAIL ADDRESS: info@fltnesSlRSUranCe-kk.Com EACH OCCURRENCE $1,000,000 INSURERS) AFFORDING COVERAGE NAIC # MED EXP (Any one person) $10000 INSURER A: Nationwide Mutual Insurance Com all 23787 INSURED _ INSURERS: Carmen M. Whitmer INSURER C: 3229 Pasadena Ave INSURER D: Long Beach, CA 90807 GENERAL AGGREGATE $5,000,000 INSURER E: A Member of the Sports, Leisure & Entertainment RPG INSURER F: COVFRGriFR roo•ric,r.11 . ........ nCVIJI MY IVUry1OCR: 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 HAVE BEEN REDUCED BY PAID CLAIMS, INSF LTR TYPE OF INSURANCE ADDL INSR SUER Me POLICY NUMBER POLICY EFF MMIDD/YV POLICY EXP MM/DD/VV LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE�OCCUR X 6BRPG0000005342300 05/31/2013 1:57AM EDT 05/31/2015 12:01 AM EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $500,000 PREMISES Eaoccurrence MED EXP (Any one person) $10000 PERSONAL& ADV INJURY $1,000,OOD GENERAL AGGREGATE $5,000,000 PRODUCTS-COMP/OP AGG DEVIL AGGREGATE LIMIT APPLIES PER: POLiCV _j PROJECT EDLOC $1,000,000 PROFESSIONAL LIABILITY $1,000,000 LEGAL LIAB TO PARTICIPANTS $1,000,000 COMHI NED SINGLE LIMIT AUTOMOBILE LIABILITY ANY AUTO SCHEDULEDryryr•} ALL OWNED AUTOS DAUIOS N HIREDAUTOS JAOTOSWNHL Not provided while In Hawaii gqW`-°� ,L� r�?✓�M �s✓ O.I A,� Ee Accident BODILY INJURY (Per person) BODILY INJURY (Perawidahc PROPERTY pAMAGE Per accltlent UMBRELLA LIAB OCCUR EXCEBSLIAB CLAIMS - MADE LED F—IRETENTION taut Olty AttO ney EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY V / N ANY PROPRIETORSHIP/PARTNERI WC STATU- TORY LIMITS OTHER E. L. EACH ACCIDENT EXECUTIVE OFFICERIMEMHER EXCLUDED (Mandatory I n NH) N / A E.L. DISEASE -EA EMPLOYEE If DESCRIPTION DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DESCRIPTION OF UTTE777IONSI LOC N V 1 -LES (Attach AC101, Itional merneres Somanne, Certified Instructor of: ZUMBA® It more space is required) The certificate holder is added as an additional insured, but only with respect to the liabilit CERTIFICATE HOLDER arisin out of the operations of the insured named above. The City of Santa Ana, officers, employees, agents and representatives SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center PlaZa THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE Santa Ana, CA 92701 WITH THE POLICY PROVISIONS. (Owner/Lessor of Premises) AUTHORIZED REPRESENTATIVE %*'_I�r _/-� Coverage is only extended to U.S. events and activities. *' 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 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved.