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Fitness and Wellness Insurance <br />A Member of Philadelphia Insurance Companies <br />Tel: 877-438-7459 • Fax: 866-847-4046 • CA License #0377646 <br />Name: Choc V Le Account #: 79022321 <br />Address: 4 Fabriano Expiring Policy #: PHPK661902-006 <br />Irvine, CA 92620-2576 Renewal Date: 12/17/2017 <br />Policy Type: General and Professional Liability <br />Policy Limits: $1,000,000 / $3,000,000 <br />Total Balance Due*: $172.00 <br />Total charge includes insurance premium, applicable taxes, and a $50 Risk Purchasing Group administration fee <br />that is fully earned and non-refundable. If you have made changes to your operations, such as producing videos, <br />leasing or purchasing a facility, or hiring employees, please call customer service for a revised premium. <br />This payment notice is being sent thirty (30) days prior to the expiration of your current policy. Your policy has <br />been automatically renewed and issued and is enclosed. If payment is not received by your policy expiration date, <br />your renewal will be automatically canceled. Available payment options are below. <br />Questions? Please call customer service 877-438.7458 <br />If payment has already been made, please disregard this notice. If you do not wish to renew your current coverage, <br />please send an email to service(cDphly corn specifying the insured name and address, policy number, policy term, <br />effective date of cancellation and reason for cancellation. If this is brokered business please contact your agent to <br />cancel. <br />Please note the following payment options for renewal of your insurance coverage: <br />1. You can renew via Visa or MasterCard on-line at PHLY.com or by contacting our customer service <br />department at 877-438-7459. <br />2. You can renew via check made payable to Fitness and Wellness Insurance by mailing your <br />payment notice and check to: <br />Fitness and Wellness Insurance <br />P.O. Box 70251 <br />Philadelphia, PA 19176-0251 <br />Note: If you have a landlord, facility owner, or other party to be listed as an additional insured, <br />please attach a list including name and mailing address. <br />All correspondence should be sent to: <br />Philadelphia Insurance Companies <br />Attention: Customer Service <br />One Bala Plaza, Suite 100 <br />Bala Cynwyd, PA 19004 <br />Please detach here <br />® Fitness and Wellness Insurance <br />If you are an IDEA member and your membership has lapsed, please go to <br />your membership prior to making payment. <br />Membership #: Membership Expiration Date: <br />Phone: Email: <br />activate <br />Name: Choc V Le <br />Account#:79022321 <br />Expiring Policy #: PHPK661902-006 <br />Expiration Date: 12/17/2017 <br />Total Balance Due: $172.00 <br />