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?!. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIPD/YYYY)
<br />TYPE OF INSURANCE
<br />12/30/2017
<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 />O.R.PKPDUGER, 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 />S-UBRO'GATIO'N IS WAIVED, subject to th'e terms qnd 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
<br />K &K Insurance Group, Inc,
<br />1712 Magnavox Way
<br />Fort Wayno IN 46804
<br />CONTACT NAME: Mass Merchandising Underwriting
<br />A/c No No, 1 -800- 506 -4856 FAX No): 1- 260 -459 -5590
<br />E-MAIL
<br />ADDRESS: info @fitnessinsurance- kk.corrl
<br />PROD CE
<br />CUSTOMER ID;
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />EACH OCCURRENCE
<br />INSURED
<br />INSURER A: Nationwide Mutual Insurance Company
<br />23787
<br />INSURER B:
<br />MED EXP (Anyone person)
<br />V. Villiam J Moyers
<br />'1204 Liftie Creek Road
<br />`Durham, NO 27713
<br />A Member of the Sports, Leisure & Entertainment RPG
<br />INSURER c:
<br />$1,000,000
<br />-
<br />INSURER D:
<br />GENERAL AGGREGATE
<br />INSURER E:
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY pRa LOO
<br />JECT
<br />OTHER:
<br />PRODUCTS -COMP/OP AGG
<br />INSURER F:
<br />PROFESSIONAL LIABILITY
<br />$1,000,000
<br />r:nvFRA�FS CERTIFICATE NUMBER: W01151252 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 />NOTWITHS'T'ANDING 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 />SUQH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTIR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM /DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS
<br />MADE a OCCUR
<br />6BRP00000006255600
<br />0110112018
<br />12:01 AM EDT
<br />01/0112019
<br />12:01 AM
<br />EACH OCCURRENCE
<br />$1,000,000
<br />GENT
<br />D GE r'o E T D
<br />PREMISES Ea Occurrence
<br />$1 ,000,000
<br />MED EXP (Anyone person)
<br />$5,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$5,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY pRa LOO
<br />JECT
<br />OTHER:
<br />PRODUCTS -COMP/OP AGG
<br />$1,000,000
<br />PROFESSIONAL LIABILITY
<br />$1,000,000
<br />LEGAL LIABTO PARTICIPANTS
<br />$1,000,000
<br />AUTOMOBILELIABIL.ITY
<br />ANY AUTO
<br />OWNED AUTOS SCHEDULED
<br />ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />NOT PROVIDED WHILE IN HAWAII
<br />I
<br />COMB ED G E MIT
<br />Ea accident
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE
<br />Peraccident
<br />UMBRELLA LAB OCCUR
<br />EXGE8S LIAR CLAIMS -MADE
<br />DED RETENTION
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/ Y / N
<br />EXECUTIVE OFFICER /MEMBER
<br />EXCLUDED? (Mandatory In NH)
<br />If yes, describe under DESCRIPTION
<br />OF OPERATIONS beloW
<br />N/A
<br />OTHER
<br />STATUTE OTHER
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE --EA EMPLOYEE
<br />E.L. DISEASE- POLICYLIMIT
<br />MEDICAL PAYMENTS FOR PARTICIPANTS
<br />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: Tai Chi -
<br />cFRTIFICATF HOLDER CANCELLATION
<br />'EVidonee of Coverage
<br />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
<br />V
<br />'%,(' �•�yyy� •�
<br />.7T.•
<br />Coverage is only extended to U.S. events and activities,
<br />`* NOTICE To TEXAS INSUREDS: The Insurer fortho purchasing group may not be subject to all the insurance laws and regulations of the State of Texas
<br />ACORD 25 (2016/03) The ACORD name 1DUB -2015 ACORD CORPORATION, All rights reserved.
<br />e and logo are registered marks of ACORD
<br />
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