CERTIFICATE OF LIABILITY INSURANCE |
DATE (MM/DD/YYYY)
12/25/2018 |
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 SADLER & COMPANY, INC. P.O. BOX 5866 COLUMBIA, SOUTH CAROLINA 29250-5866 |
CONTACT NAME: Sports Dept |
PHONE (A/C, No. Ext): 800-622-7370 | FAX (A/C, No): 803-256-4017 |
E-MAIL ADDRESS: instructor@sadlersports.com |
PRODUCER CUSTOMER ID#: |
INSURED Leslie Alex Baril 1R Brooklyn , NY 11218 Application ID: 239935 A Member of the Sports, Leisure & Entertainment RPG |
|
INSURER(S) AFFORDING COVERAGE | NAIC # |
INSURER A: Nationwide Mutual Insurance Company | |
INSURER B: | |
INSURER C: | |
INSURER D: |
COVERAGES | CERTIFICATE NUMBER | 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. |
INSD LTR |
TYPE OF INSURANCE |
ADDL INSD |
SUBR WVD |
POLICY NUMBER |
POLICY EFF (MM/DD/YYYY) |
POLICY EXP (MM/DD/YYYY) |
LIMITS | |
A |
COMMERCIAL GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR ____________________ ____________________ GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT LOCOTHER |
X | 6BRPG0000006255900 | 12:01AM ET 08/18/2018 | 12:01AM ET 08/18/2019 | |||
EACH OCCURRENCE | $500,000 | |||||||
DAMAGE TO RENTED PREMISES (fire legal liability) | $500,000 | |||||||
MEDICAL EXP (other than participant) | $5,000 | |||||||
PERSONAL & ADV INJURY | $500,000 | |||||||
GENERAL AGGREGATE (other than products-completed operations) | $5,000,000 | |||||||
PRODUCTS-COMP/OP AGG | $500,000 | |||||||
PROFESSIONAL LIABILITY | $500,000 | |||||||
LEGAL LIAB TO PARTICIPANTS | $500,000 | |||||||
ABUSE, MOLESTATION, HARRASSMENT OR SEXUAL CONDUCT DEFENSE COSTS REIMBURSEMENT | $100,000 | |||||||
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS NOT PROVIDED WHILE IN HAWAII |
||||||||
COMBINED SINGLE LIMIT (Ea Accident) | ||||||||
BODILY INJURY (Per person) | ||||||||
BODILY INJURY (Per accident) | ||||||||
PROPERTY DAMAGE (Per accident) | ||||||||
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS-MADE DEDUCTIBLE RETENTION |
||||||||
EACH OCCURRENCE | ||||||||
AGGREGATE | ||||||||
WORKERS COMPENSATION AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED?(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below |
N/A | |||||||
PER STATUE OTHER |
||||||||
E.L. EACH ACCIDENT | ||||||||
E.L. DISEASE - EA EOMPLOYEE | ||||||||
E.L. DISEASE - POLICY LIMIT | ||||||||
MEDICAL PAYMENTS FOR PARTICIPANTS | ||||||||
PRIMARY MEDICAl | ||||||||
EXCESS MEDICAL |
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Instructor of Personal Training, (CERTIFIED) Re: Urban Associates, LLC, The Brodsky Organization, LLC, 400 West 59th Street Partners, LLC, Brodcom West Development Co, Beaux Arts II, LLC, Beaux Arts Realty, LLC, Park South Towers Associates, 400 West 59th Street Partners, LLC, 12 East 86th Street LLC, 200 West 60th Street Associates LLC, 42/9 Residential, LLC, 420 West 42nd Street, LLC, 24 Fifth Avenue Associates, LLC, West, Pierre Associates, LLC, Morningside Associates, LLC, City Point Residential, LLC, 7 Dekalb Owners, LLC, J.S.B. Properties, LLC are added as additionally insured The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. |
CERTIFICATE HOLDER | CANCELLATION |
RELATIONSHIP: Property Owner/Lessor Urban Associates, LLC 400 West 59th Street Third Floor New York, NY 10019 |
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 |
ACORD 25 (2014/01) | © 1988-2014 ACORD CORPORATION. All rights reserved. |
ISO | Commercial General Liability Forms | 07/01/04
POLICY NUMBER: 6BRPG0000006255900 | COMMERCIAL GENERAL LIABILITY |
INSURED: Leslie Alex Baril | CG 20 26 04 13 |
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
1. Name of Additional Insured Person(s) or Organizations(s): |
Urban Associates, LLC 400 West 59th Street Third Floor New York, NY 10019 |
(Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) |
A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and |
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. |
Date Added: 08/17/2018 04:27:07 PM
CG 20 26 04 13
Page 1 of 1
Copyright. Insurance Services Office, Inc., 2012