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OLYMPIC TKD ACADEMY
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Last modified
8/14/2019 9:15:25 AM
Creation date
6/16/2011 12:43:22 PM
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General - Type
Insurance
General 2 - Date
6/16/2011
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TE <br />A CERTIFICATE OF LIABILITY INSURANCE DA05/16/20 4�) <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(les) 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-13PAHicCNo <br />CONTACT <br />NAME: <br />Ext): 800-745-2409 Fac No : 630-665-7294 <br />P.O. BOX 4200 <br />WHEATON, IL 60189 <br />www.fdean.com <br />E-MAIL <br />ADDRESS: info@fdean.com <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURERA: United States Fire Insurance Company 21113 <br />-----------•------ <br />800-745-2409 <br />INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND <br />ITS PARTICIPATING MEMBERS <br />INSURERS: <br />INSURER C : <br />Walter Castillo DBA Olympic TKD Academy <br />7209 Arlington Ave. Suite F <br />Riverside, CA 92503 <br />INSURERD: <br />INSURERE: <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER: USP151693 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 NI <br />VD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDDNYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 1XIOCCUR <br />X <br />SRPGP-101-0414 12:002014 0 2:01 015 <br />12:00 AM 12:01 AM <br />APPROVED <br />GENERAL AGGREGATE $2,000,000.00 <br />PRODUCTS -COMP/OP AGG $2,000,000.00 <br />PERSONAL BADV 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 />X POLICY IE T LOC <br />MED EXP (Any one person) $0.00 <br />$ <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY Auro <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTO X AUTOS <br />COMBINED SINGLE LIMIT <br />Ea accident $ <br />Per <br />BODILY INJURY (Per person) g <br />BODILY INJURYPer accident) $ <br />( <br />PROPERTY DAMAGE <br />Per accident $ <br />UMBRELLA LLAB <br />EXCESS LIAR <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE S <br />AGGREGATE $ <br />DED RETENTION $ <br />$ <br />Sexual Abuse and Molestation <br />EACH OCCURRENCE $ <br />GENERAL AGGREGATE $ <br />GL Premium: <br />$615.00 <br />DESCRIPTION OF OPERATIONS I 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 F <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 />
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