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4CC)R" OF LIABILITY INSURANCE DATE (MM,fDDfYYYY) <br />CERTIFICATE: <br />E 3/10/2017 <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(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 such endorsement(s). <br />PRODUCER CONTACT <br />Reindeer Insurance Services NAME: <br />PHONE (56,2)406-8838 <br />14037 Pioneer Blvd .__IFAX, No I: (562)406-8837 <br />E-MAIL csrQtruckbypass.com <br />Norwalk CA 90650 <br />INSURER(S) AFFORDING COVERAGE I! NAC # <br />INSURER A : United States Fire Insurance Company <br />INSURED Toyarria Karate DO INSURER B <br />Rodolfo Cazalez INSURER C <br />1030 Moore Street INSURER D <br />Santa Ana, CA 92704 INSURER F <br />INSURER F <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 Wff[l RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ADDL <br />SUER <br />POLICY EFF <br />POLICY EXP <br />LTR <br />TYPE OF INSURANCE <br />INSP <br />MQ <br />POLICY NUMBER <br />(MMfODfYYYyJ <br />fMMfDDIYYYY) <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />S2,000,000 <br />1 \/I <br />CLAIMS -MADE L/\ OCCUR <br />AH—GA26932-002 <br />01/01/2017 <br />01/01/2018 <br />DAMAGE TO RENTED <br />PREMISES �Ea occurrence$100,000 <br />ME D EXIP lAny one person 1 <br />S 5,000 <br />...... <br />_PERSONAL & ADV ]NJ - URY <br />$1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PEK: <br />GENERAL. AGGREGATE <br />S4,000,000 <br />PRO- F-] <br />E-1 <br />POLICY JECT LOC <br />PRODUCTS - COMRYOP AGG , <br />S <br />S <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />�Ea accident) <br />S <br />ANY AUTO <br />SODfLY INJURY (Per person) <br />S <br />OWNED SCHEDULED <br />. . . . ...... <br />BODILY INJURY (Po accident) <br />S <br />AUTOS ONLY AUTOS <br />PROPERTY DAMAGE <br />HIRED NON -OWNED <br />AUTOS ON L Y AUTOS ONLY <br />._{Ee LL) <br />S <br />UMBRELLA LIAR OCCUR <br />EACH OCCURRENCE <br />S <br />EXCESS LJAB CLAWS -MADE <br />TF <br />AGGREGATE <br />$ <br />D RETENTION G <br />WORKERS COMPENSATION <br />PER.... <br />OTH- <br />STATUTE ER <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORiPARTNER/EXECUTIVE <br />OFFIGERWEMBER EXCLUDED? II <br />NIA <br />E.L. EACH ACCIDENT <br />S <br />{Mandatory in NH) <br />II describe under <br />re, <br />E L, DISEASE - EA EMPLOYEE. <br />S <br />yes <br />DESCRIPTION OP OPERATIONS belowE.L. <br />DISEASE -POLICY LIMIT <br />S <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />Karate School <br />vertificate Holder is Listed as Additional Insured <br />CERTIFICATE HOLDER <br />CITY OF SANTA ANA <br />CANCELLATION <br />SHOULD ANY OF I HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />20 CIVIC CENTER PLAZA M- 16 EXPIRATION DATE THEREOF, NOTICE WILL 13h DLIAVERED IN ACCORDANCE WITH <br />PO BOX 1988 1 rHF POLICY PROVISIONS <br />