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���i� <br />Fitness and Wellness Insurance <br />A Member of Philadelphia Insurance Companies <br />Tel: 877- 438 -7459 � Fax: 866- 847 -4046 � CA License #0377645 <br />�5a P N O yif` <br />Z <br />ti f N <br />�. <br />~TU rz n�,c" <br />Name: Chihiro Savo Expiring Policy #: PMPK803569 -000 <br />Address: 106 Yorktown Ln Renewal Date: 12/08/2012 <br />Costa Mesa, CA 92626- Policy Type: General and Professional Liability <br />Policy Limits: $1,000,000 / $3,000,000 <br />Total Balance Dus': $232.00 <br />Total charge inokides insurance premium, applicable taxes, and a 550 Risk Purchasing Group sdmiMStration lee tliat Is fuNy earned and non - <br />re(undable. gyou have made changes to your operations, such ea producing vkieos, teasing or purchasing a (aclNly, or hirhig employees, <br />please caN wstomer service 1br a revised premium. <br />This payment notice b bekW sent er,kty (30) days prbr b the expMatkm o1 your current poicy. Your poHCy has Uwen autornaticaMy rerrewed and <br />bsued end K enclosed. If payment b not rocelved by your policy expirotkan date. Your renewal will be sutomatiealy canceled. Available <br />payment opYons are beknv. <br />Questions? Please call customer service 877 -438 -7459 <br />ff payment has already been made, please �sreg�ard this notice. If you do not wish to renew your current coverage, <br />please send an email to custservis2ohlvins.com specifying the insured name and address, policy number, policy term, <br />effective date of cancellation and reason for cancellation. if this Fs brokered business please contact your agent to <br />cancel. <br />Please torte the following payment options for renews( of your insurance coverage: <br />1. You can renew via Visa or MasterCard on -line at www.fitnessandwelJness.com or by contacting our <br />customer service department at 877 - 438 -7459_ <br />2. You can renew via check made payable � Fitness and Wellness insurance by mailing your <br />payment notice and check to: <br />FFtness and Wellness insurance <br />Lodcbox #6771 <br />P.O. Box 8500 <br />Philadelphia, PA 19178 -6771 <br />AN correspondence should be sent to: <br />Philadelphia Insurance Companies <br />Attention: Customer Service <br />One Bala Plaza, Suite 100 <br />Bala Cynwyd, PA 19004 <br />Note: K you have a landlord, facil/ty owner or other petty to be Nsled as en edd/t/ona/ lnsun3d, <br />please attach a Net IncJuding name and maN/ng address. <br />Please detach hero <br />Fitness and Welkness Insurance <br />ff you are an IDEA member and your membership has lapsed, please go to www.ldeaflt.com to activate <br />your membership prior to making paymenR. <br />Membership #: Membership Expiration Date: <br />Phone: <br />Email: <br />If you are a Yoaa Journal member and your membership has lapsed, please go here to activate your <br />membership prior to making pa ant. <br />Nam ®: Chihiro Sano <br />Expiring Policy #: PHPK803569 -000 <br />Expiration Date: 12/08/2012 <br />Total Balance Due: 1232.00 <br />