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1 ) <br /> ACOM. CERTIFICATE OF LIABILITY INSURANCE DA / Y) <br /> 172/23/2015 <br /> THIS CERTIFICATE 15 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 BYTHE POLICIES BELOW. <br /> THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 NAME: Mass Merchandising Underwriting <br /> K&K Insurance Group,Inc, PHONE: Ext: 1-800-506-4856 Ax:(a/c,NO): 11-260-459-5590 <br /> 1712 Magnavox Way E-MAIL lnfb@fltnessinsurance-kk.com <br /> Wayne IN 46804 ADDRESS: nfo @fltnessinsurance kk.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERAI Nationwide Mutual Insurance Company 3787 <br /> INSURED NSURER Bi <br /> William) Meyers INSURER C: <br /> 1204 Little Creek Road NSURER D: <br /> Durham,NC 27713 INSURER E: <br /> A Memberof the Sports,Leisure&Entertainment RPG&EntertainmentRPG INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:W00747278 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 SUBJ ECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF <br /> SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> NSR ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YY MM/DD/YY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY 6BRPG0000005691900 12131/2015 12/3112016 EACH OCCURRENCE $1,000,00( <br /> CLAIMS-MADE a OCCUR 12:01 AM ED 12:01 AM DAMAGE TO RENTED $300,00( <br /> PREMISES Ea occurrence <br /> MED EXP(Any one person) $5,00( <br /> PERSONAL&ADV INJURY $11000100( <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE <br /> $5,000.00 <br /> OLICY PRO- LOC PRODUCTS-COMP/OP AGG <br /> ECT 11000100( <br /> OTHER PROFESSIONAL LIABILITY $1,000,00( <br /> LEGAL LIAB TO PARTICIPANTS $1,000,00( <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> COMB <br /> ANY AUTO BODILY INJURY(Per person) <br /> SCHEDULED <br /> ALL OWNED AUTOS UTOS BODILY INJURY(Per acckdent) <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> UTO S Per accident <br /> Not provided whlle In Hawaii <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE <br /> DED ETENTION <br /> ..,WORKERS COMPENSATION PER <br /> AND EMPLOYERS'LIABILITY YIN STATUTE OTHER <br /> ANY PROPRIETORSHIP/PARTNER/ E.L.EACH ACCIDENT <br /> EXECUTIVE OFFICER/MEMBER <br /> EXCLUDED? NIA E.L.DISEASE—EA EMPLOYEE <br /> (Mandatory In NH) <br /> Il'yes,describe under E.L.DISEASE—POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS below <br /> MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL <br /> L,TIPff6r6rm i I VkHIrLb5 tALURD 101, EXCESS MEDICAL <br /> AddlUonal Remarks c u e,may De atrached if more space s requ <br /> Abuse,Molestation,Harassment or Sexual Conduct Defense Cost Reimbursement—Limit$100,000 <br /> Non-certified Instructor of:Tai Chi <br /> CERTIFICATE OLD R 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 /> AUUTyHOORIZED REPRESENTATIVE <br /> "^rvl <br /> Coverage is only extended to U.S,events and activities, <br /> "*NOTICE TO TEXAS INSUREDS:The Insurerforthe purchasing group may not be subject to all the insurance laws and regulations of the State of Texas <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 01988.2014 ACORD CORPORATION. All rights reserved. <br />