DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE 1/16/2017

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 CONTACT NAME: Richard C. Fuchs II
Richard C. Fuchs II PHONE: 800-821-7383 FAX 816-941-2750
P.O. Box 24427 E-MAIL: rfuchs@pro4.us
Overland Park, KS 66283-4427 INSURER(S) AFFORDING COVERAGE NAIC #

INSURED INSURER A: Nationwide Mutual Insurance Company 23787

Tracy Kabara
4718 N. Hollywood INSURER B:

Milwaukee, WI 53211 INSURER C:

INSURER C:
A member of the Sports, Leisure & Entertainment RPG
INSURER E:

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 ADDL SUBR
TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD

A X COMMERCIAL GENERAL LIABILITY 6b RPG 60317 3/13/2017 3/13/2018 EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES $300,000
MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1,000,000
GEN’L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000
X POLICY PROJECT LOC PRODUCTS – COMP/OP AGG

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

ANY AUTO BODILY INJURY (Per Person)
ALL OWNED AUTOS BODILY INJURY (Per Accident)

SCHEDULED AUTOS PROPERTY DAMAGE (Per Accident)

HIRED AUTOS

UNBRELLA LIAB OCCUR EACH OCCURRENCE

EXCESS LIAB CLAIMS-MADE AGGREGATE

DEDUCTIBLE

RETENTION $
PER
WORKERS COMPENSATION OTHER
STATUTE
AND EMPLOYERS LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXEC E.L EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L DISEASE – EA EMPLOYEE
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE – POLICY LIMIT

DESCRIPTION OF OPERATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)

Re: Direct selling of Mary Kay products.

Coverage is only extended to U.S. events and activities. Coverage begins and ends on dates indicated at 12:01am.

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.

ISS0009095 POL044476

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