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2023/02/15 Brenda Hawkins DBA Joyful Feet of Menifee02t't6t2023 THIS CERTIFICATE IS ISSUEO CERTIFICATE DOES NOT AFFIRMANVELY OR NEGAnVELY AMET{o, EXTEND oR ALTER THE covERAGE AFFoRoEo BY THE PorciEs aelo*.THts cERTtFtcATE oF tNsuRANcE DoEs r{or coNsITurE A cot{TRAcr BETWEEN THE tssutNc tNsuRER(S), aurHoRtzEo REFnesErrlnve OR PRODUqER,A!D THE CERNFICATE HOLOER. prov oa opolicies may r€quire an ondoiBgment A statoment on this PROOUCER K&K lnsurance Group, lnc. '1712 Magnavox Way Fort Wayne, lN 46804 coNTAcrNAilE: MM - Dance lnslruclors 1 800 506-4856 1-260459,5502 ADORESS jnfo@f tnessinsurance-kk.com PROOUCER CUSTOI/IER IO: IN SURER(S) AFFOROING COVERAGE INSUREO Brenda Hawkins DBA: Joytul teet o, Menifee 29995 Evans Rd [4enifee, CA 92586 A Member ofthe Spods, Leisure & Entertainment RPG IISURERA: MarkellnsuranceCompany 38970 I SUREi B: INSURER C: I{SURER O: INSURER E: INSURER Fi ^cfu CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER: U0002921 5 REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION City of Menifee 29844 Haun Rd Menitee, CA 92586 Owirer/Manager/Lessor of Premises SI{OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THE REOF, NO1ICE WLL BE OELIVEREO IN PROVTStONS.ACCOROANCE wlTH THE POLICY AUTXORIZEO REPR€SENTATIVE e,# 4-^rI-/ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO INDICATED, NOTWTHSTANDING ANY REOUIREIrlENT. TERM OR CONDITION OE ANY CONIRACT OP OTHER DOCUMENT WTH R:SPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. IHE INSURANC| ^F;OROEO AY THE POLICILS DESCRIBED rlERElN lS SUBJECT TO ALL THE IERMS. EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOVIN MAY HAVE SEEN REDUCED 8Y PAID CLAIMS. TYPE OF INSURANCE tNso !rMlTs COMMERCIAL GEtIERAL LlABltlTY OCCUR GEN'L AGGREGATE LIMIT APPLIES PER POLICY OTHER LOC X X ,\ r1 M1RPG0000000016500 4hr , o2115t2023 12139 AM EDT a\I ozJ15t2024 12 01 AM \, EACH OCCURR€NCE $1,000,000 PRETIISES (Ea Ocorence)$1.000,000 MED ExP (Any ono p€6or)$5.000 PERSONAL &AOV]NJURY $1.000,000 GENERAL AGGREGATE $5.000.000 PROOUCTS- COMP/OP AGG $1,000.000 PROFESSIONAL LIABILITY $1.000,000 $1.000.000 AUTOMOBIIE LIABILITY O\A/NED AUTOS ONLY HIREO AUTOSONLY SCHEDULEO AUIOS NONIV! ED AUTOSONLY rf U I .tf I (t E'"!:['"Ri''Elgl]- e{rv rurunvfe, rerm'r-t ,\r flrvruuaLs,o-lf Y :EB.TYo!uAGE ' =- 1_ ,fl UiIBRE.LA LAB EXCESSLIAB OCCUR CLAIMS.MADE oEo l-l RETENTlON eecroccunaercE Q -AGGREGATE woaxERs co PEr{sAlor IND EIPIOYERS' LI SUTY ANY PROPRIEIOF'PARTN€F' EXECUTIVE OFFICER/MEMBER EXCLUDED? {iLnditory ln H} It y6s d.sciiL.e 6d.. D€SCRIPTDN OF OPERATIONS b.Id N/A I STATUTE l__-lornen E L EACH A@IO€NI E L USEASE - EA EMPLOYEE E.t . ASEASE - POLICY UUTT MEDICAI PAYMENTS FOR PARTICIPANTS EXCESS MED CAL oEscRtPIloN oF oPERAnONS/ LOCATTONS / VEHICLES (ACORD lo',l. Addltlon.l R..n.rt! Sch.dule, m.y b..tr.ch.d It nolt 3Prc.l. r.qulr.d) Non Certifed lnstructor ol: Country western,Salsa,Swing The Certilicate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acls or omissions of the named insured The ACORD n.me and logo .ro r€gbtorrd mark ot ACORD O 1988-2015 ACORD CORPORATION. All righ6 relt.ved to the and POLICY NUMBER NOT PROVIDEO!T+I]LE IN IIAWAII EIS3; E E tr trLLt Cov€rage is mV en€od€d to U.S. e\,cnts ard adivilies.- NOTI-CE TO iEres INSUREDS] The lnsrr€f br tl|e purchesing group may not be subiql to all th6 insul'arlco lau/s and rrgulations of the Siate of To€s acoRo 25 (20't6/03) POLICY NUMBER: M1RPG0000000016500 CO MERCIAL GENERAL LIABILITY cG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Name Of Additional lnsured Person (s)OrO rganization(s) City of Menifee 29844 Haun Rd Menifee. CA 92586 Named lnsured Brenda Hawkins DBA: Joyful feel of l\4enifee lnformation required to complete this Schedu le, if not shown above. will be shown in the Declarations A. Section ll - Who ls An lnsurcd is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the ac{s or omissions of lhose acting on your behalf: l. ln the performance of your ongoing operations: or 2. ln connection with your premises owned by or rented to you. However: l. The insurance afforded to such additional insured only applies to the extent permitted by lawi and 2. lf coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreemenl to provide for such additional insured. B. Wth respecl to the insurance afforded to these additional insureds, the following is added to Secuon lll - Limib Of ln3urrnce: lf coverage provided to the additional insured is required by a contract or agreemenl, lhe most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of lnsurance shown in the Declarations: whichever is less. This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations. cG 20 26 04 13 @ lnsuranc€ Services Office, |nc.,2012 Page I of 1 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE MARKEL INSURANCE COMPANY trilEr MEMBER CERTIFICATE CERTIFICATE NUMBER: U00029077 OAIE: O2t1StZO23 THIS CERTIFICATE REPRESENTS INSURANCE PROVIDED IN ACCORDANCE WTH THE FOLLOWING MASTER POLICY NUMBER: M1RPG0000000016500 FIRST NAMED INSURED (MASTER POLICY HOLOER): Sports, Leisure and Entertainment Risk pu rchasing Group IN RETURN FOR THE PAYMENT OF THE PRE MIUM AND SUBJECT TO ALL THE TERMS OF THE MASTER NSURANCE AS STATED IN THIS CERTIFICATE.POLICY WE AGREE TO PROVIDE THE I NAMED INSURED (CERTIFICATE HOLOER) Name and Mailing Address (No., Street, Town or City, Brenda Hawkins DBA: Joyful feet of Menifee 29995 Evans Rd Menifee, CA 92586 Effective Date: 0211512023 2:0Expiration Dale: 0211 NThis replaces prior County, State, Zip Code) at 12:39 AM EDT Plan Administered rkel IK&K lnsurance Group, lnc 1712 Magnavox Way Fort Wayne lN 46804 750 18 ontact lnformation Producer Name: MM - Dance lnstructors Phone 1-800-506-4856 Fax: 1-260-459-5502 Email: info@fitnessinsurance-kk.com 1712 Magnavox Way Fort Wayne, lN 46804 K&K lnsurance Group, I nc b-- By Phone: 1-800-237 -2917 By Fax. 1-312-381-9077 By E-mail By Mail KK.Claims@kandkinsurance.com K&K lnsurance Group, lnc. 1712 Magnavox Way P.O. Box 2338 Fort Wayne, lndiana 46801 Online: www.kandkinsurance.com MCGL 1002 07 21 Page 1 of3 To Report A Claim Description Of Operations, Premises, And O perations Description Of Operations: Non Certified lnstructor of: Country Western,Salsa,Swing Premises And Operations: Location No. Address Refer to MGL 1576 Operations Limits of lnsurance Commercial General Liability General Aggregate Products/Completed Operations Aggregate Personal And Advertising lnjury Each Occurrence Damage to Premises Rented To You Medical Expense $5,000,000 $1,000,000 $1,000,000 $1,000,000 $1,000,000 $s,000 Any One Person or Organization Any One Premises Any One Person Additional Goverages ln addition to the Commercial General Liability coverages shown above, the following additional coverages are provided. lf a coverage is not listed below, such coverage, including its corresponding endorsement, does not apply to this Member Certificate. Limit Of lnsurance Bodily lnjury to Participants $1,000,000 EachOccurrence Professional Liability $1,000,000 Each Wrongful Act Limit Abuse, Molestation, or Exploitation Defense Cost Reimbursement $100.000 Per Claim / $'l00,000aggregate per policy period Endorsements Forms and endorsements applying to this Member Certificate and made part of the policy at time of issue Refer to master policy including all state amendatory endorsements applicable to the state of this Member Certificate This Member Certificate, together with the Coverage Fo]m and any Endo6ement(s) attached to the Master Policy, complete the above numbered certificate. Coverage is subject to all terms, conditions, limitations, exclusions, and other provisions contained therein. Member Certificate Premium Commercial General Liability Premium: $230.00 ,e,+A"JJ MCGL 1002 07 21 Date AUTHORIZED REPRESENTATIVE Page 2 of 3 To review the Master Policy: Please send a written request to the Plan Administrator shown above. Countersigned:o2t15t2023 By: MCGL 1002 07 21 Page 3 of3 POLICY NUMBER: M1 RPG0000000016500 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 1 INTERLINE rL 12 01 'tl 85 POLICY NUMBER M 1RPG0000000016500 POLICY CHANGES EFFECTIVE 02t15123 COMPANY Markel lnsurance Company NAMED INSURED Brenda Hawkins DBA: J oyful feet of Menifee AUTHORIZED REPRESENTATIVE K&K lnsurance Group, lnc. COVERAGE PARTS AFFECTED ALL COVERAGE PARTS CHANGES It is hereby agreed and understood that the certificate(s) of insurance to which this endorsement is attached are null and void, and no coverage is provided under this policy for any insured(s), additional insured(s), or certificate holde(s) listed on the referenced certificates. Voided Certificate(s): # U00029077, U0002921 5 cP# 1057 k$A-/J Copyright, lnsurance Services Office, lnc., 1983 Copyright, ISO Commercial Risk Services, lnc., 1983 Authorized Representative Signature tL 12 0t ll 85 Page 1 of 1 .qiAD'DATE (MfrOO/YYm 02t16t2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORUATION ONLY AND OONFEF'trORIGFTS ffiCERTIFICATE DOES iIOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTENO THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW TWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESEI{TATIVE OR PRODUCER AXD THE CERTIFICATE HOLDER. IMPORTANT: lf the cenificate holder is an ADDITIONAL INSURED , the policyliesl mustha@ e policy, certain policies may requlrc an endorsement. A statemgnt on this sndorsement(s). SUBROGATION lS WAIVEO, subj6ct to certificale does nol confer riqhts to the tho tq]ms and conditions of th cerlificate holdor in lieu of such CoNTACTNAME: MM - Dance lnstructors 1-260-459-5502 AODRESSI info@f tnessinsurance-kk.com CUSTOMER ID: INSURERIS) AFFORDING COVERAGE INSURED Brenda Hawkins DBA| Joyful feet of Menifee 29995 Evans Rd Menifee, CA 92586 A Member ofthe Sports, Leisure & Entertainment RPG INSURERA: MarkellnsuranceCompany 38970 INSURER Bl INSURER C: INSURER O: INSURER E INSURER F: CERT!FICATE OF LIABILITY INSURANCE CERTIFICATE NU'|IBER: U0002921s CANCELLATION REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AEOVE FOR THE POLICY PERIOO INDICATED NOTWTHSTANDING ANY REOUIREIVIENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V!1TH RESPECT TO \A,tiICH THIS CERIIFICATE IIIAY BE ISSUED OR MAY PERIAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUEJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOW! MAY HAVE SEEN REDUCED BY PAID CLAIMS LTR IYPE OF INSt'RANCE INSD POTICY NUMAER LIMITS X COIIIMERCIAL GE'{ERAL LIAAILITY MADE OCCUR GEN'L AGGREGATE LIiIIT APPLIES PER: POLICY OTHER LOC X X {t ,/ t\r1RPG0000000016500 lNr o2J15t2023 12:39 AM EDT 12 0211512024 1201AN \ , EACH OCCURRENCE $1,000,000 OAMAGE TO RENTED PREMISES lEa Occurenel $1,000,000 7 ,/ MED EXP (Anr one perso.)$s.000 $1,000,000 GENERAL AGGREGATE $5,000,000 PRODUCTS -COMP/OP AGG $1,000,000.-PROFESSIONAL LIAB LITY $1,000,000 BODILY NJURY TO PITICIPANTS $1,000,000 OVINEO AUTOS ONLY H RED AUTOS ONLY SCHEOULED AU'TOS NON-OVINED AUTOS ONLY NOT PROVIDEOWliILE IN HAWA]I I \,C ( / mill:H,ixi:ll' lorLv rru! reeffion;;h boorrv rrufrgg aera{ I4?5itf,^'^o' f I-.-r. ,I UMBRELLA L|AB EXCESS LIAB OCCUR CLAIMS.MADE oeo fl RETENT ON eecr occunn-Efte lf,aa / AGGREGATE WORXERS COf PEI{SA1ION AND ETPLOYERS' LIAEILITY ANY PROPR]ETOR/PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUOED? lMand.lory ln NH) Lr yes .,esdibe u.der DESCRIPTION OF OPERAT]ONS bEI@ N/A -J 8FX',,,f-l o"'* E L EACH ACCIDENT MEDICAL PAYMENTS FOR PARTICIPANTS EXCESS MEDICAL DEscRrPTroN oF oPERATtoNS / LocaltoNs /vEHtcLEs {AcoRD tol, addttionat Rlmart3 schedute, may & rtt.ched il moe sp.ce 13 rcqulrcdl Non Certifed lnstructor of: Country Western,Salsa,Swing The Cerlificate holder is added as an additional insured, but only for liability caused, in whole or in parl, by lhe acts or omissions of the named insured COVERAGES CERTIFICATE HOLDER City of N4enifee 29844 Haun Rd lrenifee, CA 92586 Owner/Manage/Lessor of Premises SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, I{OTICE wlLL BE DELIVERED IN ACCORDANCE wlTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTANVE e,# A-r/*./ Coverage is only enended to U.S. evenlsand actrvities* NOTICE TO TEXAS INSIJREDS: The lnsurer for the purchasing grcup may not be subjed to allthe insurance lau,s and rcgulations of the State oI Texas acoRo 25 (2016/03) The ACORD nanre and logo .I€ registered mark6 oI ACORD O 1988-2015 ACORD CORPORATION. All right6 r$oryed 1-800-5064856K&K lnsurance Group, lnc. 17'12 l\4agnavox Way Fort Wayne, lN 46804 PERSONAL &AOVlNJURY AUTOiIOBILE LIABILI?Y T--l PRO- T--lL ]JECT L ] ! E,L qSEASE - EA EMPLOYEE E,L dSE,d.SE . POUCY LIMIT tr POLICY NUMBER: M1 RPG0000000016500 COM'UIERCIAL GENERAL LIABILITY cG 20 26 04 t3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional lnsured Person(s)ization(s) Named lnsured Brenda Hawkins DBA: Joyful feet of Menifee lnformation required to complele lhis Schedule, i, not shown above, will be shown in the Declarations B. Vvith respect to the insurance afforded to these additional insureds, the following is added to Section lll - LimiB Of lnsurance: lf coverage provided to the additional insured is required by a contract or agreement, the mosl we will pay on behalf of the additional insured is the amounl of insurance: '1. Required by the contract or agreemenlt or 2. Available under the applicable Limits of lnsurance shown in lhe Declarations: whichever is less. This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations. cG 20 26 04 13 @ lnsurance Services Office, |nc.,2012 Page 1 of 'l City of Menifee 29844 Haun Rd [4enifee, CA 92586 A. Secton ll - Who b An lmur€d is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. ln the performance ot your ongoing operations; or 2. ln connection with your premises owned by or rented to you. However: L The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. lf coverage provided to the additional insured is required by a contracl or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.