Orange County NC Website
Browse       Search
DocuSign Envelope ID: C7EF2CCE- E471- 426C- A6EO- 32AC5FOBAF5B <br />ACORD4 <br />� CERTIFICATE OF LIABILITY INSURANCE <br />/19/ I °DIYYYYI <br />D 19 /zola <br />PRODUCER <br />Sports & Fitness Insurance <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />212 Key Drive <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Madison, MS 39110 <br />T <br />POLICYNUMSER <br />POLICYEFFECTIVE <br />DATE D <br />POLICY EXPIRATION <br />D <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURER A: General Insurance Company of America <br />Nina Maier, <br />3302 Pearson Road <br />INSURER 8- <br />EACH OCCURRENCE $ <br />INSURER C: <br />DAMAGE TO RENTED <br />PREMISES Ea occurence) <br />INSURER D: <br />Hurdle Mills, NC 27541 <br />COMKERCIAL GENERAL LIABILITY <br />INSURER E: <br />MBn EXP (Any one person) <br />rn%1Cn A r_cc <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTMNG <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS S5EH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS - <br />INSR <br />ADD' <br />N R <br />TYPE <br />T <br />POLICYNUMSER <br />POLICYEFFECTIVE <br />DATE D <br />POLICY EXPIRATION <br />D <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />1,000.000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurence) <br />a,00 000 <br />COMKERCIAL GENERAL LIABILITY <br />MBn EXP (Any one person) <br />10 $000 <br />A <br />CLAIMS MADE OCCUR <br />LPF- 962994OG <br />4/21/2018 <br />4/21/2019 <br />PERSONAL 6,ADV INJURY <br />$110001000 <br />x Professional <br />GMZERAL AGGREGATE d <br />2,000,000 <br />GEN'L AGGRHGATE LTMTT APPLIES PER <br />PRODUCTS - COMP /OP AGG <br />$2.,000,000 <br />POLICY HRO LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />{Ea accident) <br />$ <br />BODILY INJURY <br />(Per person) <br />$ <br />ALL OWNED AUTOS <br />5C j)MR D AUTOS <br />BODILY INJURY <br />(Per accident) <br />$ <br />i <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIU <br />$ <br />OTHER THAN EA ACC <br />$ <br />ANY AUTO <br />$ <br />AUTO ONLY: AGO <br />EXCESSIUMBRELLA LIABILITY <br />FACE OCCURRENCE $ <br />OCCUR DLAINS MADE <br />AGGREGATE <br />$ <br />DROUCTIBLE <br />CI <br />$ <br />$ <br />I, RETENTION $ <br />WC STATU- OTH- <br />WORKERS COMPENSATION AND <br />TORY LI T ER <br />E.L. EACH ACCIDENT <br />$ <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR /PARTNER /EXECUTI <br />OPPICER /MEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOY <br />$ <br />E.L. DISEASE - POLICY LI <br />IT $ <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS <br />Personal Trainers <br />Certificate holder is named insured. <br />rF4?T1Plr_6Tr= WnI nFR CANCELLATION <br />ACORD 25 (2001108) vVAL.0 cUI- LJKrUIwIIVfVlyaa <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />Nina Maier <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br />3302 Pearson Road <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />Hurdle Mills, NC 27541 <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2001108) vVAL.0 cUI- LJKrUIwIIVfVlyaa <br />