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DocuSign Envelope ID: 1546E635-9OE6-47DB-A413-373CA8A49D89 <br /> e DATetMMmDmYri <br /> A a CERTIFICATE OF LIABILITY INSURANCE 4/17/2019 <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 <br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain pin]ic[as may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> CONTACT WEB PRODUCER -PT <br /> Sports&Fitness Insurance Comp NAMe: <br /> P,O.Box 1967 PHONE (601)898-8464 FAX (fifll)707-1020 <br /> Madison,MS 39130 'Vc N4 <br /> AtL <br /> ADDRESS, <br /> � p <br /> DRE olfnla s ortsfitness.corn <br /> INSURER 5 AFFORDING COVERAGE NAIC A <br /> INSURER A:General Insurance Company of America 24732 <br /> INsuREDNina Maier, INSURER e: <br /> 3302 Pearson Road <br /> Hurdle Mills,NC 27541 INSURIERG: <br /> INSURER D: <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERN!OR CONDITION OF ANY CONTRACT OR OTHER.DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFF PDLIDY IXP LIMITS <br /> LTR H YYY POLICY NUMBER MMIDDI tNMIt7D <br /> GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 <br /> K— DAMAUE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY PREMISeS Ea occurrencal $ 1,000,000 <br /> CLAIMS-MADE ©OCCUR MED EXP(Any one person} $ 10,00 <br /> Professional... LPF-9629S40H 4I2112015 4/21/2020 PERSONAL&ADV IWURY $ 1,000,000 <br /> GENERAL,AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 <br /> POLICY PRO LOC $ <br /> AUTOMOBILE LIABILITY COMgINE0 SINGLE LIMIT <br /> Ea 0PaP nl <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE S <br /> HIRED AUTOS AUTOS Per accident <br /> S <br /> UMBRELLA]JAB OCCUR EACH OCCURRENCE S <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S <br /> DED RETENTION$ S <br /> WORKERS COMPENSATION VX STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y I N <br /> ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA E.L.EACHACCIDENT $ <br /> OFFICEWMEMBER EXCLUDED? <br /> (Mandatary In NH] E,L.DISEASE-EA EMPLOY $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ <br /> ❑ESCRIPTION OF OPERATIONSI LOCA'nONS I VEHICLES(Attach ACORD Ia1,Additional RemaricsSchedute,if more space is required) <br /> See Page 2 <br /> CERTIFICATE HOLDER CANCELLATION <br /> Linda Borkowski <br /> 2824 Summenlvind SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Chapel Hill,NC 27515 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESEN TIVE <br /> J <br /> ©1988-201 a ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />