2019-725-E Aging - Arlene Bynum-Mills wellness instructor

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DocuSign Envelope ID: F873FAOB-E013-47A0-B039-586A4CCBDCE8 CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDDIYYYY) 06/01/2019 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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER CONTACT NAME: Mass Merchandising Underwriting K&K Insurance Group,Inc. PHONE No.Ext: 1-800-506-4856 A 1-260-459-5590 1712 Magnavox WayArc Ne: Fort Wayne IN 46804 ADDRESS: info@fitnessinsurance-kk.com PRODUCER CUSTOMER ID; INSURER(S)AFFOROING COVERAGE NAIC N INSURED INSURERA; Nationwide Mutual Insurance Company 23787 Arlene Bynum INSURER B: DBA:Arlene Bynum INSURER C: 4816 Barbee Road Durham,NC 27713 INSURER D: A Member of the 5ports,Leisure&Entertainment.RPG INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W01454909 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. IN SR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD NIVD MPVDD MMIDDNYYY A X COMMERCIAL GENERAL LIABILITY 6ERPGOODODO694DSGO 06/18/2019 061IM020 EACH OCCURRENCE $1.000,000 MADE -1 OCCUR 12:01 AM EDT 12:01 AM MA RENTED MADE PREMISES Ea Occurrence $1.000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJ URY $1 00 U 000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMPIOP AGG $1.000,000 POLICY JE LOG PROFESSIONAL LIABILITY $1,000,000 OTHER: LEGAL LIAR TO PARTICIPANTS $1,000,000 COM81NE0 1 L I AUTOMOBILE LIABILITY £a accident ANY AUTO BODILY INJURY(Per parson) OWNED AUTOS HSCHEDULED ONLY AUTOS BODILY INJURY(PeracrJden!) HIRED NON-OWNED P RTYDAMAGEAUTOS ONLYAUTOS ONLY Per accident NOT PROVIDED MILE IN HAWAII UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATID14 AND NIA PER OTHER EMPLOYERS'LIABILITY STATUTE ANY PROPRIETCRIPARTNERI Y 1 N E-L EACH ACCIDENT EXECUTIVE OFFICERIMEMBER ❑ E.L.DISEASE—EA EMPLOYEE EXCLUDED?(Mandatory In NH) It yes,describe under DESCRIPTION ELL DISEASE—POLICY LIMIT OF OPERATIONS below MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached if more space Is required) Abuse,Molestation,Harassment or Sexual Conduct Defense Cost Reimbursement—Limit$100,000 Certified Instructor of:Aerobics,Personal training 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) 01988.2015 ACORID CORPORATION. All rights reserved. The ACORD name and logo an:registered marks of ACORD