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DocuSign Envelope ID:593338F8-59C1-4A9D-92DC-A91318C543A3
<br /> Certification Infor'm'ation
<br /> Certification organization Certification number (if Expiration date (if any)
<br /> NASM 1501209331 07/07/2017
<br /> Total Commercial General Liability 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 balloon; Airport; Amusement'
<br /> devices (the ownership, operation,'maintenance or use of: any mechanical or non-mechanical ride, slide, or
<br /> water slide, any inflatable recreational device, any bungee operation or equipment, any vertical device or
<br /> equipment used for climbing-either affixed or temporarily erected,or dunk tank. Amusement,
<br /> devices do not include any video or computer games or any device that is specifically designed for the
<br /> training or instruction of the activity for which you are enrolled); Animals (injury or death to or injury,
<br /> 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 (CG0001 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 entertainment industry; Fungi or bacteria; Haunted attractions; Lead; Medical,,
<br /> therapy or health care services; Nuclear energy liability; Operation,ownership or management of a fitness,
<br /> dance or sports facility;.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; Weight control programs;
<br /> Those operations listed as ineligible: Acrobatic/Partner yoga Instructors, Certified athletic trainers, Coaching
<br /> of organized competitive.athletic teams, Cycling (other than stationary),".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 on or in
<br /> open water. - - - -
<br /> Terms &Conditions:
<br /> 1. Premiums are 100%fully earned when coverage begins and non-refundable.
<br /> ( 2. Any exposure changes that deviate from the original enrollment form must be reported in writing.
<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 /> Warranty, &'Discilosure, --
<br /> I understand that the insurance company, in determining whether to provide insurance coverage, will
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