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7' <br />Policy Numbs(: Date Entered: 1/15/2016 <br />ACC R'o CERTIFICATE �SURANCE <br />1 <br />OF LIABILITY <br />v/1111 a/xo s <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 BY THE POLICIES <br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of auch endorsements . <br />PRODUCER <br />Reindeer Insurance Services <br />14037 Pioneer Blvd <br />Norwalk CA 90650 <br />CONTACT <br />AARA:.- <br />NE <br />UUMN (562)406-8838 iacN1(562)406-8837 <br />INNIAl truckbypasa@yahoo. com <br />-AWA9 <br />— INSURERI6)AFFORDIN000VERAGE _ <br />NAICN <br />INSURERA:HOUStOD Casualty Ins CO <br />' <br />INSURED Toyama Karate DO <br />INSURER E:apierta Insurance company <br />INSURERe <br />Rodolf0 Casales <br />INSURERO: <br />2521 N. Grand Ave Unit A <br />INSURER E: <br />Santa Ana, CA 92705 <br />INSURER P : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INS <br />TR <br />TYPE OF INSURANCE <br />�` <br />POLICYNUMSER <br />POLICYEFF <br />MDLpTe P <br />LIMITS <br />A <br />COMMERCIAL 09NERALUABILITY <br />CLAIMS-MAOE® OCCUR <br />15-7005165 <br />`,s' .�l �:j <br />e`'iTy�r eLA <br />V <br />1/1/2016 <br />1/1/2017 <br />EACH OCCURRENCE <br />$2,000,000 <br />pX MISS ETD �oR�7,6a <br />g100,000 <br />MEDEXP An aIw arson <br />$5,000 <br />^ v <br />PERSONAL SAW INJURY <br />§1,000,000 <br />— <br />DEN AGGREGATE LIMIT APPLIES PER: <br />_ POLICY ❑ JEC LOC <br />OTHER. <br />AGGREGATE <br />§A, OOOr 000 <br />_GENERAL <br />PRODUCTS AGG <br />S . <br />AUTOMOSILEUABi1TY <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY _ AUTOS <br />HIRED NON•OWNED <br />AUTOS ONLY AUTOS ONLY <br />'(Hy <br />�•+'tt44//11 <br />C <br />§nn <br />GJ`,rs <br />COMBINED SINLE LIMIT <br />jEa <br />§ — <br />BODILY INJURY (Per person) <br />3 <br />EDGILY INJURY(Per awoont <br />§ <br />PROPERtt DAMAGE <br />eRLAR I I <br />§ <br />3 <br />UMORBLLALIAB <br />EX0938 LU <br />OCCUR <br />CLAIMS•MAPE <br />('•`� v1�+Y�U^ <br />v('. e <br />li <br />Q+ <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />_ <br />OEOI I NETENTKIN <br />f <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />My PROPRIETORMARTNEMEXSCUTNE YIN <br />OFFICCRJMEMEER EXCLUDED? � <br />(MandatoryInNN) <br />11yyes.tlesaebo YndN <br />DESCRIPTION OF OPERATIONS babes <br />NIA <br />CA37339-2 <br />1/1/2016 <br />1/1/2017 <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />EL. DISEASE• 6A EMPLOYEE <br />S1 ,000r000 <br />E.I. DISEASE: -POLICY LIMIT <br />31,000 10 OO <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 191.Memo=]Rama&s Sameduls, may be mUsahod N mom apace is regulmd) <br />Karate School <br />Certificate Bolder is Listed as Additional Insured <br />CITY OF SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 CIVIC CENTER PLAZA M-16 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />PO SOX 1988 ACCORDANCE W HE POLICY PROVISIONS. <br />$ANTA ANA CA 92702 AUTHORI2EO REPREft T E <br />0 198 8.201 ItCORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACOR <br />Proye,Xe using Forms Sass Plus software. v Xormseoss.eom, Improselva Pubashing WO-maoam <br />