WHITMER, CARMEN 2 -2015 - Laserfiche WebLink

Home Browse Search

ACORD,. CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDIYYYY) 05/31/2013 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 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 Mass Merch Underwriting 9 K&K Insurance Group, Inc. 1712 Magnavox Way Fort Wayne Indiana 46804 PHONE: A/C No. Ext; ggg_580-8041 FAX: (Arc, No): 260-459-5995 E-MAIL ADDRESS: info@fitnessinsurance-kk.com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Nationwide Mutual Insuran Ce Com an 23 II7 INSURED INSURER B: Carmen M. Whitmer INSURER C: 3229 Pasadena Ave INSURER D: Long Beach, CA 90807 A Member of the Sports, Leisure & Entertainment RPG INSURERS: INSURERF: COVERAGES CERTIFICATE NUMBER: W00312110 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, INSH LTR TYPE OF INSURANCE AODL INSR SUBR MD POLICY NUMBER POLICY EFF MMIDOIYY POLICY EXP MMIDDNY LIMITS A GENERAL LIABILITY X 6BRPG000OD05342300 05/31/2013 05/31/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY Cl-Ni FX --]OCCUR 1:57 AM EDT 12:01 AM DAMAGE TO RENTED PREMISES Eaoccurrence $500,000 MED EXP (Any one person) $10,000 PERSONAL&ADM INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PROJECT ❑LOC PRODUOfe-COMP/OP AGO $1000,000 PROFESSIONAL LIABILITY $1,000,000 LEGAL LIAB TO PARTICIPANTS $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Accident ANY AUTO BODILY INJURY (Per parson) SCHEDULED ALL OWNED AUTOS UTOS BODILY INJURY(Peraccident) ON -OWNED HIRED AUTOS DUTOS PROPERTY DAMAGE Per accident Not provided while in Hawaii UMBRELLA LIAB OCCUR by. EACH OCCURRENCE EXCESS LIAB CLAIMS -MACE AGGREGATE OEO RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORSHIP/PARTNER/ = EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA` Silvia 6U U FD�/'hQ A/q IC OSA A Vas ,) YGl II/ mj�^ ' WC STU- TORYTALIMITS OTHER E.L. EACH ACCIDENT EL. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DE RIPTI N F PERATI N 1 L ATI N LE A ach A RD 101, Additional Remarks chedule, If more space s required) Certified Instructor of: ZUMBA& The certificate holder is added as an additional insured, but only with respect to the liability arisino out of the operations of the insured named above. .nano ra PJGQ. is Center Plaza Ana, CA 92701 :r/Lessor of Premises) ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE I THE POLICY PROVISIONS. 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 (2010105) The ACORD name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved.