2025-394-E-DEAPR-Nishith Trivedi-Martial Arts & Tai Chi Instruction

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Docusign Envelope ID:3EAC63A1-E275-4337-928E-E4701947E6BF CERTIFICATE OF LIABILITY INSURANCE DATE 03/02/2025 ) 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). PRODUCER CONTACT Francis L.Dean NAME: 12800 University Drive PAIiC,NNo,EXt: adC,No): (630)665-7291 Suite 125 E-MAIL Fort Myers,FL 33907 ADDRESS: fdean.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Great American Insurance Company 16691 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP)AND INSURERB: ITS PARTICIPATING MEMBERS: Tiger PaSaRyu Martial Arts DBA Nishith Trivedi INSURERC: 318 Clarkson Ridge Lane INSURERD: Hillsborogh,NC 27278 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: GAP139399 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR wVD MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300,000 PREMISES(Ea occurrence) CLAIMS-MADE FX]OCCUR 01/PAC 4725038 12 AM 04/01/2026 MED EXP(Any one person) $0 A X HOST LIQUOR LIABILITY INCLUDED X 12:00 AM 12:01 AM 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 X POLICY PRO LOC JECT A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per AUTOS AUTOS accident HIRED AUTO NON-OWNED PROPERTY DAMAGE AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION $ A Professional Liability x PAC 4725038 04/01/2025 04/01/2026 EACH OCCURRENCE $1,000,000 12:00 AM 12:01 AM AGGREGATE LIMIT $1,000,000 A Abuse and Molestation x PAC 4725038 04/01/2025 04/01/2026 EACH OCCURRENCE $100,000 12:00 AM 12:01 AM GENERAL AGGREGATE $300,000 AD&D AGGREGATE $500,000 AAccident/Medical Coverage BSR-E885960-02 04/01/2025 03/31/2026 AD&D $100,000 12:00 AM 11:59 PM MAXIMUM MEDICAL $100,000 DEDUCTIBLE $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. The Certificate Holder is added as an additional insured but only with respect to liability arising out of the named insured during the policy period. Scheduled Activities Exclusion Applies-Please Refer to Named Insured Member Certificate of Coverage CERTIFICATE HOLDER CANCELLATION Orange County, NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED PO Box 8181 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Hillsborogh, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Fra-vt.c�is�L. Dea.w ACORD 25(2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD