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DocuSign Envelope ID: 165D3B4D-D069-4060-B893-CE23BF8F28D4 <br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE DA E(MM/DD 5�) <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 BELOW. <br /> THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZEC <br /> ',RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> ,ORTANT: 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 /> CONTACT <br /> PRODUCER NAME: Mass Merchandising Underwriting <br /> K&K Insurance Group, Inc. PHONE: 1-800-506-4856 FAX:(A/C,No): 1-260-459-5590 <br /> 1712 Magnavox Way -MAIL Ext <br /> Fort Wayne IN 46804 ADDRESS: info @fitnessinsurance-kk.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA: Nationwide Mutual Insurance Company 23787 <br /> INSURED INSURER B: <br /> Alicia Arence Reid INSURER C: <br /> 3508 Borland Road INSURER D: <br /> Efland,NC 27243 INSURER E: <br /> A Member of the Sports, Leisure&Entertainment RPG INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:W00666613 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 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 MM/DD/YY MM/DD/YY <br /> A X COMMERCIAL GENERAL LIABILITY 6BRPG0000005691900 07/1312015 07/13/2016 EACH OCCURRENCE $1,000,00( <br /> CLAIMS-MADE OCCUR 12:28 AM ED 12:01 AM DAMAGE TO RENTED $300,00( <br /> PREMISES Ea occurrence <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,0(1( <br /> GENERAL AGGREGATE <br /> GEN';AGGREGATE LIMIT APPLIES PER: <br /> $5,000,00( <br /> POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG <br /> JECT $1,000,00( <br /> OTHER PROFESSIONAL LIABILITY $1,()(10,(1(1( <br /> LEGAL LIAB TO PARTICIPANTS $1,(10(1,0(1( <br /> A COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY <br /> Ea Accident <br /> ANY AUTO BODILY INJURY(Per person) <br /> ALL OWNED AUTOS SCHEDULED BODILY INJURY(Per accident) <br /> [,AUTOS <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> UTOS Per accident <br /> Not provided while in Hawaii <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DED I IRETENTION <br /> WORKERS COMPENSATION PER OTHER <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE__ <br /> ANY PROPRIETORSHIP/PARTNER/ <br /> EXECUTIVE OFFICER/MEMBER E.L.EACH ACCIDENT <br /> EXCLUDED? N/A E.L.DISEASE—EA EMPLOYEE <br /> (Mandatory in NH) <br /> If yes,describe under E.L.DISEASE—POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS below <br /> MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL <br /> EXCESS MEDICAL <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Abuse,Molestation,Harassment or Sexual Conduct Defense Cost Reimbursement—Limit$100,000 <br /> Certified Instructor of:Aerobics,Aquatic exercise,Exercise, Personal training, Pilates,Spinning,Strength,Yoga <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 ACCORDANCE <br /> WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <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 1 <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. <br />