Browse
Search
2016-482-E Aging - Kathleen Hammon - wellness instructor
OrangeCountyNC
>
Board of County Commissioners
>
Contracts and Agreements
>
General Contracts and Agreements
>
2010's
>
2016
>
2016-482-E Aging - Kathleen Hammon - wellness instructor
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/6/2016 3:17:29 PM
Creation date
9/1/2016 10:46:35 AM
Metadata
Fields
Template:
BOCC
Date
8/23/2016
Meeting Type
Work Session
Document Type
Contract
Agenda Item
Manager signed
Amount
$4,000.00
Document Relationships
R 2016-482-E Aging - Kathleen Hammon - wellness instructor
(Linked To)
Path:
\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2016
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
5
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
DocuSign Envelope ID:270479C5-FCF2-4407-B265-35CF6C5408CF <br /> AC► CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> `... 07/27/2016 <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 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE <br /> OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If <br /> SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT NAME: Mass Merchandising Underwriting <br /> K&K Insurance Group,Inc. PHONE 1-800-506-4856 FAX 1-260-459-5590 <br /> 1712 Magnavox Way <br /> (A/C,ANo,Ext): (A/C,No): <br /> Fort Wayne IN 46804 ADDRESS: info @fitnessinsurance-kk.com <br /> PRODUCER <br /> CUSTOMER ID: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Nationwide Mutual Insurance Company 23787 <br /> Kathleen C Hammon INSURER B: <br /> 1102 E Franklin St. INSURER C: <br /> Chapel Hill, NC 27514 <br /> A Member of the Sports, Leisure&Entertainment RPG INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: W00884488 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br /> SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER PODCYEFF POLICY EXP LIMITS <br /> LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) <br /> A X COMMERCIAL GENERAL LIABILITY 6BRPG0000005861300 07/27/2016 07/27/2017 EACH OCCURRENCE $1,000,000 <br /> CLAIMS- 11:07 AM EDT 12:01 AM DAMAGE TO RENTED $300,000 <br /> MADE X OCCUR PREMISES(Ea Occurrence) <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $5,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 <br /> POLICY PE o- LOC PROFESSIONAL LIABILITY $1,000,000 <br /> OTHER: LEGAL LIAB TO PARTICIPANTS $1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) <br /> OWNED AUTOS SCHEDULED BODILY INJURY(Per accident) <br /> ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> NOT PROVIDED WHILE IN HAWAII <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> — <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DED n RETENTION <br /> WORKERS COMPENSATION AND N/A PER OTHER <br /> EMPLOYERS'LIABILITY _STATUTE <br /> ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT <br /> EXECUTIVE OFFICER/MEMBER <br /> EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE <br /> If yes,describe under DESCRIPTION E.L.DISEASE-POLICY LIMIT <br /> OF OPERATIONS below <br /> MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL <br /> EXCESS MEDICAL <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Abuse,Molestation,Harassment or Sexual Conduct Defense Cost Reimbursement—Limit$100,000 <br /> Non-certified Instructor of: Exercise <br /> CERTIFICATE HOLDER 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 <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE �,�..}r�"' „ �- <br /> 4-�v l <br /> Coverage is only extended to U.S.events and activities. <br /> **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 <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
The URL can be used to link to this page
Your browser does not support the video tag.