2016-524-E Aging - Carson Stuart - wellness instructor

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DocuSign Envelope ID:OACCB29C-0691-414F-9F98-51B46D8CD387 f.4 ACCORD CERTIFICATE OF LIABILITY INSURANCE oy�ti16DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Robert Kuchefski NAME: Hoffman Insurance Services,Inc. PHONE 877-235-0406 ext.145 FAX 781-235-6665 /C 141 Linden Street (A .No.Ext): (A/C,No): PO Box 9002 E-MAIL robertk @hoffmaninsurance.com Wellesley,MA 02482-9002 PRODUCER Phone:781-235-0087 CUSTOMER ID#: Fax:781-235-6665 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Philadelphia Indemnity Company Carson Stuart INSURER B 903 Emory Drive INSURER C: INSURER D: Chapel Hill NC 27517 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY X 40849 02/03/2016 02/03/2017 PREMISES(Ea occurrence) $100,000 CLAIMS-MADE X OCCUR X MED EXP(Any one person) _ $1,000 Prof Liab Inc! PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY JECOT LOC ABUSE&MOLESTATION $100,000/$300,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Policy#: 40$49 I Master Policy#: pHPK1445932 Program Information: NA$M (e.g.ACE)I Member#: 14133719 For a complete listing of coverage forms,please visit to www.InsurePersonalTrainers.com/resources. NOTE:All premium is fully earned at inception of policy It is understood and agreed that the certificate holder is named as additional insured,but only as respects its liability arising out of the activities of the named insured. CERTIFICATE HOLDER See enclosed for Additional Insured CANCELLATION Functional Fitness 02/02/2016 @ 10:45 pm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 605 Eastowne DR. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Suite C (ADDITIONAL INSURED) Chapel Hill NC AUTHORIZED REPRESENTATIVE 27514 h � ' . ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD