CAZALES, RODOLFO DBA TOYAMA KARATE-DO ORGANIZATION 2-2017

Home Browse Search

4C4r_>RI7 CERTIFICATE OF LIABILITY INSURANCE � DATE(MM0/22017017 Y) 3/1 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(lea) must have ADDITIONAL INSURED provisions or 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 Reindeer Insurance Services 14037 Pioneer Blvd Norwalk CA 90650 CONTACT NA E: PHONE (562)906-8838 Fax (562)406-8837 s INC Noj;,_ EMAIL esr@truckbypass. com ARPgg@.aL_.._._._....._........ _..._ ..... ..__ INSURER($) AFFORDING COVERAGE NAIC# INSURER A; United States fire insurance Company $2,000,000 INSURED Toyama Karate DO t Rodolfo Ca2alez INSURER B: INSURER G: 01/01/2017 1030 Moore Street INSURER D: S 100,000 Santa Ana, CA 92104 INSURER E: INSURER F: 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. NSR T TYPE OF INSURANCE ADOL INSD SUER VAG POLILYNUMBER POLICY EFF MleurnyYYYl POLICY EXP (MMIDONyWI LIMITS .a. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS4ADE 1zOCCUR AH-OA26932-002 01/01/2017 01/01/2018 DAMAGE TO RENT Pffg I SEa occurrence S 100,000 MED EXP (Any one person) $5,000 PERSONAL a ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 _ POLICY F—] JECPROT D LOC PRODUCTS - COMP/OP AGO 5 S OTHER: AUTOMOBILE LIABILITY _.._.._ COMBINED SINGLE LIMIT Ea accident S BODILY INJURY (Per person) S i ANYAUTO -.OWNED. SCHEDULED AUTOS ONLY € AUTOS _.�..-.... INJURY( BODILY INJURY Per accident Per _____m__._.....�..__.. $ _ . �` NON -OWNED ! AUTOS ONLY ''. AD7GB ONLY PROPERTY DAMAGE Ver accident S UMBRELLA LIAR_ OCCUR EXCESS LIAR._ CLAIMS -MADE �y y4�1. EACH OCCURRENCE S AGGREGATE S �'\Q/ OED I RETENTION S � S WORKERS COMPENSATION PER OTH� AND EMPLOYERS' LIABILITY YIN "�, STATUTE ER E.L. EACH ACCIDENT S ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED' 1� N f A ('.V V �� E,I I. DISEASE - EA EMPLOYEE 5 (Mandatory In NH) If yes, deserts under DESCRIPTION OF OPERATIONS below ' y�� .. \ E.L. DISEASE POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS( VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) Karate School -certificate Holder is Listed as Additional Insured CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA 20 CIVIC CENTER PLAZA M-16 PO BOX 1988 SHOULD ANY OF THE ABOVE DESCRI RED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE W ILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.