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ryrl Fitness and Wellness Insurance A Member of Philadelphia Insurance Companies Tel: 877 - 438 -7459 • Fax: 866 - 847 -4046 • CA License #037 Name: Chihiro Sano Expiring Policy #: Address: 106 Yorktown Ln Renewal Date: Costa Mesa, CA 92626- Policy Type: Policy Limits: Total Balance Due *: '645 ID PHPK803569 -001 12/08/2013 General and Professional Liability $1,000,000 / $3,000,000 $232.00 Total charge includes insurance premium, applicable taxes, and a $50 Risk Purchasing Group administration fee that is fully earned and non- refundable. If you have made changes to your operations, such as producing videos, leasing or purchasing a facility, or hiring employees, please call customer service for a revised premium. This payment notice is being sent thirty (30) days prior to the expiration of your current policy. Your policy has been automatically renewed and issued and is enclosed. If payment is not received by your policy expiration date, your renewal will be automatically canceled. Available payment options are below. Questions? Please call customer service 877 - 438 -7459 If payment has already been made, please disregard this notice. If you do not wish to renew your current coverage, please send an email to custservophlyins.com specifying the insured name and address, policy number, policy term, effective date of cancellation and reason for cancellation. If this is brokered business please contact your agent to cancel. Please note the following payment options for renewal of your insurance coverage: 1. You can renew via Visa or MasterCard on -line at www.fitnessandwellness.com or by contacting our customer service department at 877- 438 -7459. 2. You can renew via check made payable to Fitness and Wellness Insurance by mailing your payment notice and check to: Fitness and Wellness Insurance Lockbox #6771 P.O. Box 8500 Philadelphia, PA 19178 -6771 All correspondence should be sent to Philadelphia Insurance Companies Attention: Customer Service One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004 Note: If you have a landlord, facility owner, or other party to be listed as an additional insured, please attach a list including name and mailing address. Please detach here E3Fitness and Wellness Insurance If you are an IDEA member and your membership has lapsed, please go to www.ideafit.com to activate your membership prior to making payment. Membership #: Phone: Membership Expiration Date: Email: If you are a Yoga Journal member and your membership has lapsed, please go here to activate your membership prior to making payment. Name: Chihiro Sano Expiring Policy #: PHPK803569 -001 Expiration Date: 12/08/2013 Total Balance Due: $232.00