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AC0f2Drr, CERTIFICATE OF LIABILITY INSURANCE DATE(M2/201) 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 INSUREDS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsements . PRODUCER CONTACT NAME: Mass March t)ndelwfitin g K&K Insurance Group, Inc. 1712 Magnavox Way Fort Wayne Indiana 46604 PHONE: c, No. Bai : 888-580-8041 ITFAX: (AIC, No): 260-459-5995 E ADOREss: Info@fitnessinsumnoe-kk.com INSURERS) AFFORDING COVERAGE NAIC It INSURER A: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: Carmen M. Whitener INSURER C: �.`.Y. .. INSURER M 3229 Pasadena Ave - Long Beach, CA 90807 A Member of the Sports, Leisure & Entertainment RPG INSURER E: W INSURER F: CnVPRA n PR CERTIFICATE NUMBER: W00633577 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO' I' WITHSTANDING 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, INSR LTR TYPE OF INSURANCE ADDL INSO SUBR MAD POLICY NUMBER POLICYEFF MMIDONY POLICYEXP MMIDD" LIMITS A X COMMERCIAL GENERALLIABILITY X 6BRPG0000005515500 06/3112015 05/31/2017 EACHOCCURRENCE $1,000,00 7—x CLAIMS -MADE X OCCUR 12:01 AM EDT12:01 AM DAMAGE TO RENTED PREMISES Ea occurrence $500,000 MED EXP(Any one person) $10000 PERSONAL &ADV INJURY $1,000,00 GENERWAGGRCGATE GEN': AGGREGATE LIMIT APPLIES PER: per yea 5 000 000 PRO DEC POLICY ❑ JECT PRODUCTS-GOMP/OPAGG per year $1,00000 OTHER PROFESSIONALUABILITY $1,000,00 LEGAL UAB TO PARTICIPANTS $1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Accident,-,,,,Y BODILY INJURY (Per person) JANYAUTO SCHEDULED ALL OWNED AUTOS AUTOS BODILY INJURY (Par accident) .m^ PROPERTYDAMAGE Peraccident HIRED AUTOS NON -OWNED UTOS Not provided while in Hawaii MBRELLA LIA6 OCCUR EACH OCCURRENCE AGGREGATE EXCESS JAB CLAIMSMADE b RCTENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N PER STATUTE OTHER E.L. EACH ACCIDENT ANY PROPRIETORSHIPIPARTNER/ EXECUTIVE OFFICERVEMBER EXCLUDED4 N/A E.I_ DISEASE - EA EMPLOYEE (Manda(ory In NH) If yos, describe under E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS below MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL E RIP I A CA ON EHI L O .A IEona Remarks chetlule, may aattaohatl more space is required) Certified Instructor of., ZUMBA® The certificate holder is added as an additional Insured, but only for liability caused, in whole or in part, by the acts or omissions of the named Insured. CERTIFICATE HOLDER CANCELLATION 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. AUTHORIZED REPRESENTATIVE (Owner/Lessor of Premises) 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 Blithe incur nce n",,fACORD 2512014101) The ACORD name and logo are registered marks of ACORD g awed. Carmen Acosta PRCSA ec e�ati n a