Representative Officer
Resume:
POLICY CHANGE DOCUMENT
POLICY NO:
CHANGE # 2 CHANGE EFFECTIVE: 09/29/2022
Page 1 of 1
Philadelphia Indemnity Insurance Company PRODUCER: InterWest Insurance Services, LLC. - Chico
NAMED INSURED: James Eckart
MAILING ADDRESS 243 Susquehanna Ave
Lansdale, PA 19446-
POLICY PERIOD: FROM 08/21/2022 TO 08/21/2024 at
12:01 A.M. Standard Time at your mailing address shown above. DESCRIPTION:
In consideration of the premium reflected, the policy is amended as indicated below: Added 1 Additional Insured.
Total Annual
Additional/Return Premium $0.00
Total Prorate
Additional/Return Premium $0.00
Total Annual
Additional/Return
Tax/Surcharge/Fee $0.00
Total Prorate
Additional/Return
Tax/Surcharge/Fee $0.00
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/29/2022
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 have ADDITIONAL INSURED provisions or 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
InterWest Insurance Services, LLC. - Chico
1357 E. Lassen Ave. Sut 100 PO Box 8110
Chico, CA 95973
CONTACT
NAME:
PHONE
(A/C, No, Ext):
FAX
(A/C, No):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Philadelphia Indemnity Insurance Company 18058 INSURED
James Eckart
243 Susquehanna Ave
Lansdale, PA 19446
INSURER B :
INSURER C:
INSURER D :
INSURER E :
INSURER F :
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. INSR
LTR TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X PHPK2172970-001 08/21/2022 08/21/2024 EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence) $100,000
X PROFESSIONAL LIABILITY MED EXP (Any one person) $2,500 PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY PROJECT LOC PRODUCTS - COMP/OP AGG $3,000,000 OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO BODILY INJURY (Per person) $
OWNED AUTOS
ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS
ONLY
NON-OWNED
AUTOS ONLY
PROPERTY DAMAGE
(Per accident) $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
$
Y / N
PER
STATUTE OTHER
N / A E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) It is understood and agreed that the following entity is added as an additional insured but only with respect(s) to the operations of the named insured except that liability resulting from the additional insured's sole negligence.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
JimLifeFitness
243 Susquehanna Ave
Lansdale, PA 19446
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/29/2022
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 have ADDITIONAL INSURED provisions or 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
InterWest Insurance Services, LLC. - Chico
1357 E. Lassen Ave. Sut 100 PO Box 8110
Chico, CA 95973
CONTACT
NAME:
PHONE
(A/C, No, Ext):
FAX
(A/C, No):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Philadelphia Indemnity Insurance Company 18058 INSURED
James Eckart
243 Susquehanna Ave
Lansdale, PA 19446
INSURER B :
INSURER C:
INSURER D :
INSURER E :
INSURER F :
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. INSR
LTR TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X PHPK2172970-001 08/21/2022 08/21/2024 EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED
PREMISES (Ea occurrence) $100,000
X PROFESSIONAL LIABILITY MED EXP (Any one person) $2,500 PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY PROJECT LOC PRODUCTS - COMP/OP AGG $3,000,000 OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO BODILY INJURY (Per person) $
OWNED AUTOS
ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS
ONLY
NON-OWNED
AUTOS ONLY
PROPERTY DAMAGE
(Per accident) $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
$
Y / N
PER
STATUTE OTHER
N / A E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) It is understood and agreed that the following entity is added as an additional insured but only with respect(s) to the operations of the named insured except that liability resulting from the additional insured's sole negligence.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Upper Dublin Township
370 COMMERCE DR
Fort Washington, PA 19034
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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