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ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />GATEYYYY) <br />12/02/2002/2D19 <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 BELOW. <br />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 polic (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 such endorsement(s). <br />PRODUCER <br />K&K Insurance Group, Inc. <br />1712 Magnavox Way <br />Fort Wayne IN 46804 <br />CONTACT NAME: Mass MerChandlsing <br />WC,No Exit: 1-800-64&6406 PaC No; 1-260-459-5940 <br />E-MAIL <br />ADDRESS: info@danceinsurance-kk.com <br />PRODUCER <br />CUSTOMER to, <br />INSURE S AFFORDING COVERAGE <br />NAIC F <br />INSURED 2001198810 CP# 1583 <br />Silvia Saldado <br />610 S. Clara St <br />Santa Ana, CA 92703 <br />A Member of the Sports, Leisure & Entertainment RPG <br />INSURER A: Nationwide Mutual Insurance Company <br />23787 <br />INSURER a: <br />INSURER C: <br />INSURER D; <br />INSURER E; <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 2000449942 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 INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />MR <br />LTR <br />TYPE OF INSURANCE <br />ADOL <br />INSD <br />SUER <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />DDIYYY <br />POLICY EXP <br />MWDD/YY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />X <br />6BRPGOWO006933600 <br />01/01/20 <br />01/01/21 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAMS MADE FX 1 OCCUR <br />12:01 AM <br />12.01 AM <br />DAMAGE TO RENTED <br />PREMISES Occimence <br />$1.000.000 <br />MEDEXP(Arryarepenlom <br />$5,000 <br />PERSONAL B ADV INJURY <br />$1,000.000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$5,000,000 <br />POLICY PROJECT ❑ LOC <br />PRODUCTS -COMPIOP AGG <br />$1,000,000 <br />PROFESSIONAL LIABILITY <br />$1,000,000 <br />OTHER: <br />LEGALLIASTOPARTIGPANTS <br />$1,ODO,000 <br />AUTOMOBILE LIABILITY <br />acodimt <br />BODILY INJURY Fe, I>QreOn) <br />AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AL rOS <br />BODILY INJURY (Par acvtleal) <br />AM <br />PROPERTY DAMAGE <br />HIRED NON -OWNED <br />AUTOSONLY AUTOS ONLY <br />Per aostlem <br />XI <br />X Not provided while in Hawaii <br />IJAB OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />EXCESS LIAB CLAIMS MADE <br />DED RETENTION <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />NIA <br />PER STATUTE OTHEA <br />ANY PROPRIETORPARTNER YIN <br />E.L. EACH ACCIDENT <br />EXECUTIVE OFFICERMEMBER <br />EXCLUDED? (Mandatory in NM <br />E.L DISEASE- EA EMPLOYEE <br />E-L DISEASE- POLICY LIMIT <br />II yyes, dou nba under <br />DESCRIPTION OF OPERATIONS below <br />MEDICAL PAYMENTS FOR PARTICIPANTS <br />PRIMARY MEDICAL <br />EXCESS MEDICAL <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more specs Is reRWred) <br />Certified Instructor of: Zunrl <br />The City of Santa Ana, officers, agents, employees, and volunteers are added as an additional insured, but only for liability caused in whole or in part. by the <br />acts or omissions of the named insured. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana Risk Management Division <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />20 Civic Center Plaza <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH <br />Santa Ana, CA 92702 <br />THE POLICY PROVISIONS. <br />Owner/ManageriLessor of Premises <br />REV EWED & APPR <br />AUTHORIZEDREPRESENTATIVE <br />kMANAGEMFNY FYI, <br />®1988-2015 ACORD CORPORATION. All rights reserved. <br />MI N 14 2020 <br />Coverage is only extended to U.S. events an act v a THA M. LAMBERT <br />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. <br />ACORD 25 (20161'03) The ACORD name and logo are registered marks of ACORD <br />