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CERTIFICATE OF LIABILITY INSURANCE <br />D 05/15/2015 Y) <br />05/15/2015 <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 pc icy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject <br />to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to <br />the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />FRANCIS L. DEAN AND ASSOCIATES, LLC <br />1776 S. NAPERVILLE ROAD, BLDG -B <br />CONTACT <br />NAME: <br />A/CNNo Ext: 800-745-2409 A/C No: 630-665-7294 <br />E-MAIL <br />ADDRESS: info@fdean.com <br />P.O. BOX 4200 <br />WHEATON, IL 60189 <br />www.fdea n .com <br />INSURER(S) AFFORDING COVERAGE NAIC# <br />INSURERA: United States Fire Insurance Company 21113 <br />800-745-2409 <br />INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND <br />ITS PARTICIPATING MEMBERS: <br />INSURER B: <br />INSURER C : <br />Walter Castillo DBA Olympic TKD Academy <br />7209 Arlington Ave. Suite D <br />INSURER D: <br />MED EXP (Any one person) $0.00 <br />Riverside, CA 92503 <br />INSURER E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: USP180232 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE F`X] OCCUR <br />X <br />SRPGP-101-0415 <br />12:00 AM <br />12:00 AM <br />02:01 016 <br />12:01 AM <br />GENERAL AGGREGATE $2,000,000.00 <br />PRODUCTS - COMP/OP AGG $2,000,000.00 <br />PERSONAL &ADV INJURY $1,000,000.00 <br />EACH OCCURRENCE $1,000,000.00 <br />FIRE DAMAGE (Any one fire) $300,000.00 <br />GEN -L AGGREGATE LIMIT APPLIES PER: <br />Ro- <br />X POLICY JPECT LOC <br />MED EXP (Any one person) $0.00 <br />$ <br />14:PPROVF <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIREDAUTO NON -OWNED <br />AUTOS <br />COMBINED SINGLE LIMIT <br />$ <br />BODILY I <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) I $ <br />PROPERTY DAMAGE $ <br />(Per accident) <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />I CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED RETENTION $ <br />$ <br />EACH OCCURRENCE $ <br />GENERAL AGGREGATE $ <br />GL Premium: <br />$415.00 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Taekwondo <br />CERTIFICATE HOLDER CANCELLATION <br />Walter Castillo DBA Olympic TKD Academy <br />7209 Arlington Ave. Suite D <br />Riverside, CA 92503 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Francis L. Dean <br />@ 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2013/02) The ACORD name and logo are registered marks of ACORD <br />