<br />From: Mary Severson At: Murria & FricK Insurance To: Pearl Reya
<br />
<br />Fan: (858) 259.6069 Date: 117/02 01:32 PM Page 2 of 2
<br />
<br />ACQRQ.
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />OPIO )fS I
<br />0377819 01/07/02
<br />--T-THIS CERTIFICATE -IS-isSUED AS,,-NiA TfEifOF' ii'I"FOtlMATION - -
<br />I ONLY AND CONFERS NO RIGHTS UFON THE CERTJFJCATE
<br />HOLDER. THIS CERTIFICATE OOES NOT AMEND. EXTEND OR
<br />I ALTER THE COVERAGE AfFORDED BY THE POLICIES BELOW.
<br />
<br />DATE (MMlDD/YYl
<br />
<br />PROOUCER
<br />F~tness & We11ness Insurance
<br />Agency
<br />380 Stevens Ave., F~rst Floor
<br />'Solana Beach CA 92075
<br />I_~hone: 800-395-8075 Fax: 858-519-0822
<br />INSUREO
<br />
<br />I
<br />1
<br />
<br />I
<br />u__!
<br />
<br />!NSURERS AFFORDING COVERAGE
<br />
<br />Peter Mangosing #0377819
<br />Eff, 8/1/01
<br />2049 So. Pacific Ave_
<br />Santa Ana CA 92704
<br />
<br />1~ISUf'!ER~__
<br />~JSIJ~,E~_=----_
<br />
<br />IrJSURERA.
<br />
<br />Specialty National Insurance
<br />
<br />--
<br />
<br />[USURER:)
<br />
<br />COVERAGES
<br />
<br />.i:NS'..'~E~~
<br />
<br />THE POL/CIESOF INSURANCE Lr$TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEOABO\lE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAy PE~TAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1$ SUBJECT TOAll THE TERMS, EXCLUSIONS AND CONDnlONS OF SUCH
<br />POLICIEs A.GGREGATE LlMliS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />
<br />--I POLICy NUMBER I ~~~~C'Y~EFF~7yTfi" - I P::4~\.~:,:~~~J~ON -r--
<br />
<br />I~:;
<br />
<br />'!'YPEOFIN~'-'''-&-''lce
<br />
<br />GFNEIIt&llf49IlfTY
<br />A X i (;OMMEPCIAL CE'JE:.o..... (;AB!L1rv
<br />r----r-: CJ\!~S PMOF I X , OCCJ"l
<br />A Ix!~sc profes~nal
<br />r--
<br />
<br />LIMIT'!!
<br />
<br />3%:Z-126451-00
<br />
<br />08/01/01
<br />
<br />08/01/02
<br />
<br />'FArH'l<"IIP""'"C" _' ~ ~iO()O~OO__~
<br />I f-lf.!EDAMAGE:!!'r:yonE~re) r;-100; 000
<br />MED E>o.P (My ""B pBr<;{I~) $ 2 : 500
<br />"fP~()~L&Ar1VllJjURY 1.1,000,000
<br />I (;fN",PALAGGR",GATE i $ 3,000,000
<br />r-::---._--~-t-..----.
<br />rROOUC]o;.cC>,1P'O"'~' ~ 1, OO!)_, 000_
<br />,
<br />
<br />r~'L AG~f,>tGA-'-~~M~: APPI :~s~-
<br />n .~~L;CY r- - ~~27 r ,cc
<br />EOMOBILELIAIIlLITY
<br />l. .J "'-,"YAUTO
<br />,l-J ,ioU O'y'.t'LDAIJTOS
<br />WSCcTf:)'-'~E[)AU;oS
<br />, .- ~jIREDAU70S
<br />
<br />C:--OM"i,NE'D'a.;GLCLI[.<,T
<br />(E~ ~r.CJellt;
<br />
<br />!
<br />I'
<br />/,
<br />
<br />,~
<br />
<br />
<br />~~Lib~n\j
<br />
<br />i,
<br />.+-
<br />
<br />H r,Or'J-O"-'/lcE!:lAU-:-OS
<br />i !
<br />
<br />fG~GELtA!iILfTY
<br />l.. J Ai~y "0TO
<br />
<br />:>qoP[P"-Yr)AM"'G[
<br />We' '~'''~e~t:
<br />
<br />"
<br />
<br />1t::<CI!~,!:;L""'IU'r';'
<br />i .---.!' :':110 L
<br />
<br />1-1)!=oUCTIR!f'
<br />~RE'tl'mO'j
<br />
<br />V'-I.J!.;"'U-'-~L\'- d"u.~~N~ '~
<br />'OTHER EA"-~~
<br />i ALlie
<br />
<br />j
<br />
<br />.",,,
<br />
<br />" ~.L'"'' ".'Ar.",
<br />
<br />~^~W ~"'" ,~~C, ".
<br />, '--~"~...~~~~._,,~'-
<br />~
<br />
<br />WORIo<ERt COMPENSATION AND
<br />i EMPLOYERS'llIlBIUTY
<br />
<br />1,.GGRFG,4.,TEO
<br />-
<br />!-
<br />I
<br />
<br />
<br />I
<br />
<br />,
<br />.+~-
<br />------j ; -
<br />-- i:/IT=i
<br />--~--':l
<br />
<br />IOTI-iER
<br />
<br />I cL.CACHACC::::U';] !$
<br />~~~.DI~EASE-=AEMPLU;~" -~-.
<br />r--_m___n.._____,...____
<br />'I :)IS",,o.:;,. PC_ICYLlM'T
<br />
<br />A I SEXUAL ABUSE
<br />
<br />DESCRIPTION OF OpeAATlONSJlO(;ATIONSNEIiICLESlEXCLUSIONSAOOED BY ENOORSEMeNT/SPECIAL PROVISIONS
<br />It is understood and agreed that the following entity is add~d as an
<br />additional insured but only as respects the operations of the named insured
<br />except tnat liabilit.l'" resulting from the additional insUJ::-eds sole negl.i.gence
<br />
<br />100,000
<br />300,000
<br />
<br />CERTIFICATE HOLDER
<br />
<br />I Y ADOltIONAl.lfllSU'U!O:INSUReA:LEnEA::
<br />
<br />CANCELLATION
<br />
<br />CITYOFS
<br />
<br />DATe tHEReOF. TH.E ISSUING JNSURER WiLL ENOEAVCi:;: TO MAll
<br />
<br />SHOULt> jl,NY OF T;.;i! ABO"i; t.lSSCRlBEO POLIt.IES BE C.....CElli;O I5EF~E THE EXPIRJ,TIOK
<br />
<br />City of Santa Ana
<br />Pearl Raya
<br />20 Civic Center Plaza
<br />Sant~ Ana CA 92701
<br />
<br />t~OTICE TO Tl4E CERTIfiCATE HOLD!:R t-lAMED TO THE LEfT. nuT fAILURe TO 00 = SHAl..l.
<br />
<br />10 OArSWRITT"rl
<br />
<br />IMPOSE NO OBU"'ATtON OP. L!."Bl!..rn Of ."NY I<INO UPON THE IN5L'REFl. ITS AGENTS 0'"
<br />
<br />Il!!ifP"lI=SENTATIVES
<br />
<br />Jeffre E_ Frick
<br />ACORD 2S-S (7/97) @ACORDCORPORATION1988
<br />
<br />----
<br />
|