|
DocuSign Envelope ID: CE03F77E-2613-496A-9C6E-Fll685DF6CDA
<br /> Certification Information
<br /> Certification organization anyjfication number (if Expiration date (if any)
<br /> NASM 1501209331 07/07/2017
<br /> Total Commercial'General L116bil ty Premium :': $179.00
<br /> Notable Exclusions:
<br /> The-following exclusions are contained in the commercial general liability coverage, provided by this'
<br /> program. Abuse, molestation,.harassment or sexual conduct; Aircraft/hot air•bailoon; Airport; Amusement`
<br /> devices (the ownership, operation,`maintenance or use of any mechanical or non-m'echanical ride; slide; or.
<br /> water slide,;any inflatable recreational device, any bund6e operation or equipment, any vertical devcce.or
<br /> equipment used for climbing-either permanently affixed or temporarily erected; or dunk tank. Amusements
<br /> devices do not include any video or computer,games or any device,that is specifically designed:for the'
<br /> training or.instructon of the activity for which you are enrolled); Animals (injury or.death to or injury,
<br /> death or property damage caused by any animal owned, rented or hired 'by- you); Any adult-themed
<br /> parties/meetings/trips, including but-not limited to parties/meetings/trips during which demonstration of
<br /> products and/or.services :used in.-the adult entertainment industry takes place;,Asbestos; Commercial
<br /> general liability,standard exclusions 030001 04/13 edition); Employment-related.practices; Fireworks;
<br /> Fitness/exercise operations related; in whole or in part,,to performance as an exotic dancer-or any similar_;
<br /> occupation in the adult�entertalnment industry; Fungi or bacterla; Haunted attractions; Lead-
<br /> the or health care services; Nuclear energy liability; Operation,.ownership ormanagement of a fitness;.
<br /> dance or sparts'faciiity; Performers; Physicals/stress testing; Physical therapy, massage or salon services;
<br /> Rodeos, Saddle animals,'_Sale or distribution of.medicinal;`herbal and/or nutritional-products; Snowmobile;
<br /> :Training programs for law enforcement; public,safety.and military personnel; Weigh.. ntrol;programs,
<br /> Those operations listed as ineliglble: Acrobatic/Partner yoga Instructors, Certified athletic trainers, Coaching
<br /> of organized competitive athletic teams, Cycling (other than statlonary)„.Instructors under the age of 18,
<br /> Instructors operating outside of the U.S., Instruction of sports skills activities, Instructor`s employment as;
<br /> an exempt or non-exempt;employee of a`school,;university or college; Instruction/activities�,held bn or.in'
<br /> open water.
<br /> Terms&Conditions:
<br /> 1. Premiums are 100%fully earned when coverage begins and non-refundable.
<br /> 2. An exposure changes that deviate from the original enrollment form must be reported in writing.
<br /> Y P
<br /> 3. Acceptance of this quote confirms your desire to obtain liability insurance through the Sports, Leisure
<br /> and Entertainment Risk Purchasing Group. K&K reserves the right to decline any request for
<br /> coverage.
<br /> 4. Coverage is contingent upon receipt of premium payment. No coverage will be deemed in effect until
<br /> premium is received by the company or their representative.
<br /> 5. This program only provides coverage for your individual operations as an instructor.The policy does
<br /> not extend coverage for activities conducted by employees or anyone else assisting or performing on
<br /> your behalf.
<br /> 6. Commercial General Liability Broadening Endorsement:
<br /> • Expected or intended bodily injury or property damage resulting from the use of reasonable
<br /> force to protect persons or property.
<br /> • Non-owned Watercraft-extended to 58 feet.
<br /> • Supplementary Payments -$2,500 bail bonds, $500 a day loss of earnings.
<br /> • Waiver of Right of Recovery.
<br /> • Bodily Injury definition expanded to include mental anguish, mental injury,shock,fright,
<br /> humiliation, emotional distress or death resulting from bodily injury,sickness or disease.
<br /> • Damage to Premises Rented to You - the term fire is replaced with fire, lightning, explosion,
<br /> smoke and leaks from sprinklers.
<br /> • Additional Coverage:
<br /> o Emergency Real Estate Consultant Fee-$25,000
<br /> o Identity Theft Exposure - $25,000
<br /> o Key Individual Replacement Cost-$50,000
<br /> o Lease Cancellation Moving Expense - $2,500
<br /> o Temporary Meeting Space- $25,000
<br /> o Terrorism Travel Reimbursement- $25,000
<br /> o Workplace Violence Counseling - $25,000
<br /> Additional Certificate Request
<br /> Do you need to request any additional Certificate(s) of Insurance to present to a No
<br /> third party?
<br /> IS I ION
<br /> I understand that the insurance company, in determining whether to provide insurance coverage, will
<br />
|