2023-444-E-DEAPR-Nishith Trivedi-Martial Arts and Tai Chi Instruction

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ACORD 25 (2016/03)© 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/28/2023 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 endorsement(s). CONTACT NAME: PHONE(A/C, No, Ext):(800) 745-2409 FAX(A/C, No):(630) 665-7291 E-MAIL ADDRESS:ryan.kelleher@fdean.com INSURER(S) AFFORDING COVERAGE NAIC # PRODUCER Francis L. Dean 12800 University Drive Suite 125 Fort Myers, FL 33907 fdean.com INSURER A :Great American Insurance Company 16691 INSURER B : INSURER C : INSURER D : INSURER E : INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND ITS PARTICIPATING MEMBERS: Tiger PaSaRyu Martial Arts DBA Nishith Trivedi 318 Clarkson Ridge Lane Hillsborogh, NC 27278 INSURER F : COVERAGES CERTIFICATE NUMBER:GAP108229 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence)$300,000 CLAIMS-MADE X OCCUR MED EXP (Any one person)$0 PERSONAL & ADV INJURY $1,000,000 X INCLUDES ATHLETIC PARTICIPANTS GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG $2,000,000 A X POLICY PRO- JECT LOC PAC 4725034 04/01/2023 12:00 AM 04/01/2024 12:01 AM AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTO NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION $ A Professional Liability PAC 4725034 04/01/2023 12:00 AM 04/01/2024 12:01 AM EACH OCCURRENCE AGGREGATE LIMIT $1,000,000 $1,000,000 A Abuse and Molestation PAC 4725034 04/01/2023 12:00 AM 04/01/2024 12:01 AM EACH OCCURRENCE GENERAL AGGREGATE $100,000 $300,000 A Accident/Medical Coverage BSR-E885960-00 04/01/2023 12:00 AM 04/01/2024 12:01 AM AD&D AGGREGATE AD&D MAXIMUM MEDICAL DEDUCTIBLE $500,000 $100,000 $100,000 $250 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Covered activities: Martial Arts. Locations: 318 Clarkson Ridge Lane, Hillsborogh NC 27278. Scheduled Activities Exclusion Applies-Please Refer to Named Insured Member Certificate of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Proof of Insurance AUTHORIZED REPRESENTATIVE Francis L. Dean DocuSign Envelope ID: 5E4EB900-3E1E-4A3B-B716-0F8CC94B1C47