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DocuSign Envelope ID: 51 D434AE-BDB9-4D7E-9616-0AAD05E1 CC24 <br /> Fitness and Wellness Insurance <br /> A Member of Philadelphia Insurance Companies <br /> Tel: 877-438-7459 Fax: 866-847-4046 CA License#0377645 <br /> Name: Connie Winstead Account#: <br /> Address: 3000 Montgomery St Expiring Policy#: PHPK561270-004 <br /> Durham, NC 27705- Renewal Date: 04/3012015 <br /> Policy Type: General and Professional Liability <br /> Policy Limits: $2,000,000/$4,000,000 <br /> Total Balance Due*: $125.00 <br /> Total charge includes insurance premium,applicable taxes,and a$50 Risk Purchasing Group administration fee that is fully earned <br /> and nonrefundable. <br /> If you have made changes to your operations,such as producing videos, leasing or purchasing a facility, or hiring employees, <br /> please call customer service for a revised premium. <br /> This payment notice is being sent thirty(30)days prior to the expiration of your current policy.Your policy has been automatically <br /> renewed and <br /> issued and is enclosed. If payment is not received by your policy expiration date,your renewal will be automatically canceled. <br /> Available <br /> payment options are below. <br /> Questions? Please call customer service 877-438-7459 <br /> If payment has already been made, please disregard this notice. If you do not wish to renew your current <br /> coverage, <br /> please send an email to custsery @phlyins.com specifying the insured name and address, policy number, <br /> policy term, <br /> effective date of cancellation and reason for cancellation. If this is brokered business please contact your <br /> agent to <br /> cancel. <br /> Please note the following payment options for renewal of your insurance coverage: <br /> 1. You can renew via Visa or MasterCard on-line at www.fitnessandwellness.com or by contacting our <br /> customer service department at 877-438-7459. <br /> 2. You can renew via check made payable to Fitness and Wellness Insurance by mailing your <br /> payment notice and check to: <br /> Fitness and Wellness Insurance <br /> P.O. Box 70251 <br /> Philadelphia, PA 19176-0251 <br /> Note: If you have a landlord, facility owner, or other party to be listed as an additional insured, <br /> please attach a list including name and mailing address. <br /> All correspondence should be sent to: <br /> Philadelphia Insurance Companies <br /> Attention: Customer Service <br /> One Bala Plaza, Suite 100 <br /> Bala Cynwyd, PA 19004 <br /> Please detach here <br /> ---------------------------------------------------------------------------------------------------------------- <br /> COMMON POLICY DECLAMATIONS <br /> CPD-PIIC (01/07) <br /> Policy Number: PHPK561270-005 <br /> Named Insured and Mailing Address: <br /> Connie Winstead <br /> 3000 Montgomery St <br /> Durham, NC 27705- <br /> Producer: 6039 <br /> Maguire Insurance Agency, Inc. <br /> 27101 Puerta Real Suite 200 <br /> Mission Viejo, CA 92691- <br /> Policy Period From: 04/30/2015 To: 04130/2016 at 12:01 AM.Standard Time at your mailing <br /> I <br /> address shown above I <br /> Business Description: Yoga Trainer <br /> : <br /> P, <br /> b, <br /> it <br />