MADRIGAL, MARIA 3 -2015 - Laserfiche WebLink

Home Browse Search

ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYY Y) 02/1112015 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 NAME: Mass Merch Underwritin 9 K&K Insurance Group, Inc. 1712 Magnavox Way Fort Wayne Indiana 46804 PHONE: A/C No. Ext: 888-680-8041 FAX:IAIC,No): 260-459-5995 AIL ADDRESS: infoQfitnessinsurance-kk.com INSURER(S) AFFORDING COVERAGE NAIC9 INSURER A: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: Maria L Madrigal INSURER C: 2530 W Hood Ave INSURER D: Santa Ana, CA 92704 A Member of the Sports, Leisure & Entertainment RPG INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W00589697 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. INSP LTR TYPE OF INSURANCE ADDL INSD SUBR Me POLICY NUMBER POLICY EFF MMIDONY POLICY EXP MMIDDIYY LIMITS A X COMMERCIAL GENERAL^ LIABILITY 6BRPG000OGO5515600 02/13/2015 02/13/2016 EACH OCCURRENCE $1,0woo CLAIMS -MADE IX OCCUR 12:01 AM ED 12:01 AM DAMAGE TO RENTED PREMISES Ea occurrence $500 000 MED EXP(Anyona parson) $10,000 PERSONAL &ACV INJURY $1,000,00 GEM' AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 000 00 POLICY ❑PRO ❑ LOC JECT PRODUCTS-COMPIOP AGG $1 000 00 PROFESSIONAL LIABILITY $1,000,00 OTHER LEGAL LIAR TO PARTICIPANTS $1,000,0010 MOBILEUABILITV COMBINED SINGLE LIMIT Ea AccidentNYAUTO BODILY INJURY (Per person) SCHEDULED LL OWNED AUTOS UrDsBODILY RA INJURY(Praccidera) IRED AUTOSNON-OWNED UTOS PROPERTY DAMAGE Petaccidentot provided while in Hawaii UMBRELLALIA13 OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAR CLAIMS -MADE OED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER STATUTE OTHER ANY PROPRIETORSHIPIPARTNERI [ EXECUTIVE OFFICERIMEMBER EXCLUDED? MIA A EL EACHACCIOENT E.L. DISEASE— EA EMPLOYEE (Mandatory In NH) It yes, describe under E.L. DISEASE— POLICY LIMIT DESCRIPTION OFOPERATIONS below MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL MAIPTION OF OPERATIONS I i Ps A RD t, A d t ene emar a c o u a, may a aaac more apace is required) Certified Instructor of: Aerobics, Dance, ZUMBA(5 Abuse, Molestation, Harassment or Sexual Conduct Defense Cost Reimbursement- $100,000 limit 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 (2014101) The ACORD name and logo are registered marks of ACORD 01988.2014 ACORD CORPORATION. All rights 7 erved. �y41,