2017-310 Aging - William Meyers for wellness instructor

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t AC> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) o 12/30/2016 'HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS :ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOM 'HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVO )R P'RODU_CER,ANDTHE CERTIFICATE HOLDER. MPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the po icy(ies)must ave ADDITIONAL INSURED provisions or be endorsed. WBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on thig :ertificate does not confer rights to the certificate holder in lieu of such endorsement(s). o PRODUCER . CONTACT NAME: Mass Merchandising Underwriting o° C&K Insurance Group,Inc. P(n"C No ExU: 1-800-506 4856 rx NO: 1-260-459-5590 o 1712 Magnavox Way E-M I FortWayne IN 46804 ADDRESS: info@ ftnessinsurance-kk.com o PRODUCER CUSTOMER ID: + INSURER(S)AFFORDING COVERAGE NAIC# N INSURED INSURER A: Nationwide Mutual Insurance Company 23787 William] Meyers INSURER B: 1204 Little C reek Road INSURER C: Durham,NC 27713 A Memberof the Sports,Leisure&Entertainment RPG INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W00959806 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 SUBJ ECT 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 NUMBER POLIC EFF POLICY EXP LIMITS LTR INSD WVD (MMIDD/YYYY) (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY 68RPG0000006028600 0110112017 01/01/2018 EACH OCCURRENCE $1,000,000 CLAIMS- ❑OCCUR 12:OlAMEDT 12:OlAM DAMAGE TO RENTED MADE X PREMISES Ea Occurrence $300,000 MED EXP(Anyone person) $5,000 PERSONAL&ADV INJ URY $1,000,000 GENERALAGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OPAGG $1,000,000 POLICY ❑❑)ECT PRO- LOC PROFESSIONAL LIABILITY ❑ $1,000,000 OTHER: LEGAL LIAR TO PARTICIPANTS $1,000,000 AUTOMOBILE LIABILITY COMBINED INGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Perperson) ONLY D AUTOS SCHEDULED BODILY INJURY(PeraccidenU HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Weracciden NOT PROVIDED WHILE IN HAWAII UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE IDED RETENTION �r WORKERS COMPENSATION AND N/A PER OTHER EMPLOYERS,LIABILITY STATUTE LJ ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT T!!!!!!' EXECUTIVE OFFICERIMEM13ER EXCLUDEOr(Mand'atury In NH) E.L DISEASE—EA EMPLOYEE r If yes,describe under DE SC R IPTIO N OF OPERATIONS below E.L.DISEASE—POLICY LIMIT MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Abuse,Molestation,Harassment or Sexual Conduct Defense Cost Reimburse{nent—Limit$100,000 Non-certified Instructlorof Tai Chi �� CERTIFICATE HOLDER CANCELLATION Evidence of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Coverage is only extended to U.S.events and activities, 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 ACORD 25(2016103) TheACORD name and logo are registered marks of ACORD 0ISM2015 ACORD CORPORATION. All rights reserve