2015-374-E Aging - Kathleen Hammon for wellness instructor $4,000

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DocuSign Envelope ID: D3A3FB7C-F3D5-4390-A335-E1 D1DF068BE6 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 12/22/2014 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED .PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, 10RTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the ms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME Mass Merchandising Underwriting : K&K Insurance Group, Inc. PHONE` 1-800-506-4856 FAX:(A/C,No): 1-260 459-5590 1712 Magnavox Way e AIL Ext Fort Wayne IN 46804 ADDRESS: info @fitnessinsurance-kk.com INSURER(S)AFFORDING COVERAGE NAIC# MINSURERB: Nationwide Mutual Insurance Company 23787 INSURED Kathleen C Hammon 1102 E Fran klin St.Chapel Hill,NC 27514 A Member of the Sports,Leisure&Entertainment RPG INSURER F: COVERAGES CERTIFICATE NUMBER:W00570821 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YY MM/DD/YY LIMITS A X COMMERCIAL GENERAL LIABILITY 6BRPG0000005527100 01/01/2015 01/01/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE occuR 12:01 AM ED 12:01 AM DAMAGE TO RENTED $300,000 PREMISES Ea occurrence) MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE GEN';AGGREGATE LIMIT APPLIES PER: $5,000,0001 PRO- OTHER❑ JECT ❑ LOG PRODUCTS-COMP/OP AGG $1 000'000 OTHER PROFESSIONAL LIABILITY $1,000,000 LEGAL LIAB TO PARTICIPANTS $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Accident ANY AUTO BODILY INJURY(Per person) SCHEDULED BODILY INJURY Per accident ALL OWNED AUTOS UTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE UTOS Per accident Not provided while in Hawaii UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE I—IDED RETENTION WORKERS COMPENSATION PER OTHER AND EMPLOYERS'LIABILITY Y/N STATUTE ANY PROPRIETORSHIP/PARTNER/ � E.L.EACH ACCIDENT EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A E.L,DISEASE—EA EMPLOYEE (Mandatory In NH) If yes,describe under E.L.DISEASE—POLICY LIMIT DESCRIPTION OF OPERATIONS below MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DESCRIPTION F OPERATIO LO ATI VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is require Abuse,Molestation,Harassment or Sexual Conduct Defense Cost Reimbursement—Limit$100,000 Non-certified Instructor of.,Exercise CERTIFICATE HOLDER CANCELLATION Evidence of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Coverage is only extended to U.S.events and activities. **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 ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD @ 1988-2014 ACORD CORPORATION. All rights reserved.