Laserfiche WebLink
AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 01/09/2026 <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 NAME: Jennifer Lamb <br /> Jennifer Lamb Insurance Agency Mae Ext (714)209-9911 arc No <br /> 949 Williams Ave E-MAIL ennifer Ins <br /> ADDRESS: 1 @i urancelamb.com <br /> INSURERS AFFORDING COVERAGE NAIC k <br /> Placentia CA 92870 INSURER A: STATE COMPENSATION INS FUND 35076 <br /> INSURED INSURER B: <br /> Gryphon Fitness Studio LLC INSURER C <br /> 912 Magnolia Ave INSURER D: <br /> INSURER E: <br /> Placentia CA 92870 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: 1 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 IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDL SUER EFF LTR TYPE OF INSURANCE �wqn WWIPOLICY NUMBER MMIDDYIYYYY MMID�Y/YYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence S <br /> MED EXP(Any one person) 8 <br /> PERSONAL&ADV INJURY $ <br /> GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ <br /> JECT <br /> POLICY a PRO LOG PRODUCTS-COMPIOP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO HODILY INJURY(Per person) 5 <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) S <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident $ <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB Ll CLAIMS-MADE AGGREGATE $ <br /> DEn RETENTIONS �,r STATUTE $ <br /> WORKERS COMPENSATION /\ ORH <br /> AND EMPLOYERS'LIABILITY Y I N <br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000.000 <br /> A OFFICERIMEMBER EXCLUDED? N NIA X 9294833-25 04101/2025 04101/2026 <br /> (MandatoryiaNH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 <br /> It yes.describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 <br /> I <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Waiver of Subrogation <br /> APPROVED <br /> By Tu Tran Nguyen of 3:56 pm,Jan 27, 2026 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Santa Ana Attn:Parks,Recreation and Community THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Services Agency ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza M-23 AUTHORIZED REPRESENTATIVE <br /> Santa Ana CA 92701 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />