R2017-93 Temporary Closing of State Rights-of-Way Community Events Shoreline Classic

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AO Rte'® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F6/14/2017 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(les)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 NAME. Margaret Mayers STAR Insurance - Fort Wayne Office PHONE . (260)467-5690 NC NO:(260)467-5691 2130 East Dupont Road ADDRESS:margaret.mayers@starfinanc±al.com INSURERS AFFORDING COVERAGE NAIC# Fort Wayne IN 46825 INSURER A National Casualty Company 11991 INSURED INSURERBNationwide Life Insurance CO. 66869 Road Runners Club of America/2017 and Its Member INSURER C: Member Clubs INSURER D 1501 Lee Highway, Suite 140 INSURERE: Arlington VA 22209 INSURERF: COVERAGES CERTIFICATE NUMBER:2017 $1M A.I. 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 I ADL U POLICY EFFPOLICY EXP LTR TYPE OF INSURANCE INSID POLICY NUMBER MWDD/YYYY (MWDDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS-MADE FOOCCUR A 7kGE TO RENTED PREMISE Ea occurrence S 500,000 X Legal Liability to KR00000006655200 12/31/2016 12/31/2017 MED EXP(Any one person) S 5,000 Participant $1,000,000 12:01 AM 12:01 AM PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 Unlimited X POLICY 7 PE0 0 LOC Abuse s Molestation PRODUCTS-COMP/OPAGG S 1,000,000 OTHER: Aggregate $5,000,000 Abuse and Molestation $ 500,000 AUTOMOBILE LIABILITY COMBINED SINGLE LI IT S 1,000,000 Ea accident AIx ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED KR00000006655200 12/31/2016 12/31/2017 BODILY INJURY Per accident) $ AUTOS AUTOS ( HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS 12:01 AM 12:01 AM Per accident $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE s DEO RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? N/A (Mandatory in ander If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Excess Medical 6 Accident SPX0000027889600 12/31/2016 12/31/2017 Excess Medical $10,000 ($250 Deductible/Claim 12:01 AM 12:01 AM ADBSpecific Loss $2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS TO THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE OF EVENT(S) : 09/17/17 28th Annual Shoreline Classic INSURED RRCA CLUB/EVENT MEMBER: Decatur Running Club, Att'n: John Pranschke, PO Box 3397, Decatur, IL 62524 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 09/17/17 City of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 Gary K. Anderson Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Decatur, IL 62523 AUTHORIZED REPRESENTATIVE Terry Diller/MMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 oni4m)