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DocuSign Envelope ID: 11F3F293-1DBD-4644-BD53-4A0AFE6D154F <br /> ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYM <br /> 05/28/2014 <br /> HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> °.RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED <br /> . iPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the <br /> terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT NAME: Mass Merchandising <br /> K&K Insurance Group,Inc. PHONE(A/C,No.Ext): 1-800-506-4856 FAX(A/C,No): 1-260-459-5590 <br /> 1712 Magnavox Way E-MAIL ADDRESS: info @fitnessinsurance-kk.com <br /> Fort Wayne IN 46804 <br /> NSURED 10042626 CP#1569 INSURER(S)AFFORDING COVERAGE NAIC 11 <br /> Functional Fitness,LLC INSURER A: Nationwide Mutual insurance Company 23787 <br /> 05 Eastowne Dr.,Suite C INSURER B: <br /> Chapel Hill,NC 27514 INSURER C: <br /> Member of the Sports,Leisure&Entertainment RPG INSURER D: <br /> COVERAGES CERTIFICATE NUMBER:2000148082 REVISION NUMBER: <br /> HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br /> ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF <br /> SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD MMIDD MM/DO <br /> A X COMMERCIAL GENERAL LIABILITY 6BRPG0000005361800 08/21113 08/21/14 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE ❑OCCUR 12:01 AM 12:01 AM DAMAGE RENTED $300,000 <br /> PREMISES S(Ea occurrence <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 <br /> POLICY ❑PROJECT ❑LOC <br /> PRODUCTS-COMP/OP AGG $1,000,000 <br /> OTHER <br /> PROFESSIONAL LIABILITY $1,000,000 <br /> LEGAL LAB TO PARTICIPANTS $1,000,000 <br /> AUTOMOBILE LIABILITY 6BRPG0000005361800 08121/13 08121/14 COMBINED SINGLE LIMIT <br /> 12:01 A.M. 12:01 A.M. Ea Accident $1,000,000 <br /> ANY AUTO BODILY INJURY(Per person) <br /> ALL OWNED AUTOS SCHEDULED BODILY INJURY(Per accident) <br /> AUTOS <br /> X HIRED AUTOS X NON-OWNED <br /> AUTOS (Per act) <br /> d nDAMAGE <br /> X Not provided while in Hawaii <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DIED RETENTION <br /> WORKERS COMPENSATION PER OTHER <br /> AND EMPLOYERS'LIABILITY YIN STATUTE <br /> ANY PROPRIETOR/PARTNER/ E.L.EACH ACCIDENT <br /> EXECUTIVE OFFICER/MEMBER <br /> EXCLUDED? N/A E.L.DISEASE—EA EMPLOYEE <br /> (Mandatory in NH) <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS E.L.DISEASE—POLICY LIMIT <br /> below <br /> MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL <br /> EXCESS MEDICAL <br /> DESCRIPTION OF OPERATIONS I LOCATIONS—/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Location#1:605 Eastowne Dr.,Suite C,Chapel Hill, NC 27514 Facility Square Footage:2,375 <br /> On-site&Off-site coverage Professional liability is not provided for independent instructors. <br /> **This certificate voids and replaces certificate#2000112764** <br /> CERTIFICATE HOLDER CANCELLATION <br /> Evidence Of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN A, <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> F <br /> I <br /> �I <br /> Coverage is only extended to U.S.events and activities. , <br /> **NOTICE TO TEXAS INSUREDS:The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. <br /> ACORD 25(2014/01) @ 1988-2014 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br /> I <br /> i <br />