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I DocuSign Envelope ID: CF3B53E6-A7C6-4401-9C8F-158C21168A54 <br /> k ' <br /> c"j?" FDA�TE(MMIDD/YYYY) <br /> CERTIFICATE OF LIABILITTINSURANCE 2/18/2015 <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" =RTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 'BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> RE1'• ENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPOR ANT: If the certificate holder is an ADDITIONAL" INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the 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 /> RODUCER CONTACT <br /> �rancis L. Dean &Associates of Indiana,-LLC NAME: <br /> 10 West Cook Road Suite 204 a/CNe Ext: (877)732-4746 FAX WC,No: <br /> ort Wayne, IN 46825 ADDRESS: applicationslN @fdean.com <br /> dean.comlRedirectlN.htm INSURERS)AFFORDING COVERAGE NAIL# <br /> INSURERA: U.S.Fire Insurance Company 21113 <br /> ISURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP)AND INSURERS: <br /> ITS PARTICIPATING MEMBERS: <br /> o INSURER C: <br /> MICHAEL SAVINO I INSURERD: <br /> ;05 LONGLEAF DRIVE INSURERE: <br /> :HAPEL HILL, NC 27517 <br /> 119-967-1043 _ INSURERF: -- Y <br /> ;OVERAGES CERTIFICATE NUMBER: USS270751 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 <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ;R TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY FJCP - LIMITS <br /> t INSR WVD MMIDDIYYYY MMIDDIYYW <br /> ZH LIABILITY GENERAL AGGREGATE $ 3,000,000 <br /> RCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGO $ 3,000,000 <br /> LAIMS-MADE a OCCUR PERSONAL&ADV INJURY $ 1,000,000 <br /> SRPG-101-0414° 12:01 AM 2/191 AM EACH OCCURRENCE $ 1,000,000 <br /> 1 2:01 AM 12:01 AM FIREDAMAGE.(Anyonefire) $ 300,000 <br /> EGATE LIMIT APPLIES PER: MED EXR.('A y 6'person jEa Loc PROFESSIONAL LIABILITY 'Included <br /> COMBINED SINGLE LIMIT ILE LIABILITY a accident $ <br /> 7o - BODILY INJURY(Per person) $ <br /> NED gUTOSULED BODILY INJURY(Per accident) $ <br /> UTO NON-OWNED PROPERTY DAMAGE $ ' <br /> -- AUTOS Per accident <br /> $ <br /> UMBRELLA LIAB OCCUR ..EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE', $ <br /> DED RETENTION $ $ <br /> =KERSCOtAPENSATION WCSTATU- OTH <br /> AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER $ <br /> ANY PROpR iETOR/PARTNER/EXECUTIVt '—"- - - - -" -•- <br /> OFFICERiMEMSER EXCLUDED? ❑NIA.. - E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> Ryes,describe under <br /> DESCRIPTION OF OPERATIONS below ' - E.L.DISEASE-POLICY LIMIT $ <br /> !, AD&D <br /> MAXIMUM MEDICAL <br /> DEDUCTIBLE <br /> I <br /> TERMS.OF PAYMENT <br /> IESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> 3usiness Operation:"Massage and Approved Modalities" <br /> Jo coverage is provided for Hot Stone Massage ThErapy. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED.POLICIES.BE'CANCEL'LED,BEFORE <br /> _ THq EXPIRATION DATE THEREOF, NOTICE.WILL BE_ DELIVERED IN, <br /> ACCORDANCE WITH THE POLICY PROVISIONS.'- ' <br /> • t <br /> AUTHORIZED REPRESENTATIVE ti <br /> ' F�ac�iy L. Dea-w F <br /> i <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> 4CORD 26(2010105) The ACORD name and logo are registered marks of ACORD <br />