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DATE(MMIDDNYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 4/5/2018 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT NAME: y <br /> g are <br /> Mar t Mayers <br /> STAR Insurance - Fort Wayne Office PHHCONrE ) (260)467-5689 _II-If No).. <br /> (260) 67-5691 <br /> 2130 East Dupont Road E-MAILADDRESs:margaret.mayers@starfinancial.com <br /> �_.___._ 7__­ _.__::. <br /> INSURER(S)AFFORDING COVERAGE NAIC X <br /> Fort Wane IN 46825 <br /> Wayne INSURERA_National Casualty-,Company 11991 <br /> INSURED INSURER B-Nationwide Life Insurance Co 66669._ <br /> Road Runners Club of America/2018 and Its INSUIll <br /> Member Clubs INSURER D: <br /> 1501 Lee Highway, Suite 140 INSURER E: <br /> Arlington VA 22209 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:2018 $1M A.I. REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADLICY EXP <br /> DL I= POLICY NUMBER MM/DO EFF i MMIDDIYYYY LIMITS <br /> LTRIN D <br /> EACH OCCURRENCE S 1,000,000 <br /> �XL <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 500,000 <br /> A CO CLAIMS-MADE I X OCCUR PREMISES(Ea occutre_ i <br /> KR00000007170900 12/31/2017 12/31/2018,MED EXP Anyrmapetson) $ 5,000 <br /> Legal Liabilit}_to — --- <br /> _Participant $1r P00,000 12:01 AM 12:01 AM I.PERSONAL&ADV INJURY S 1,000,000 <br /> GEWL AGGREGATE LIMIT APPLIES PER: '_GENERAL AGGREGATE i$ Unlimited <br /> PRO. 1,000,000 <br /> X POLICY' JECT ___ L� Abuse s Molestation PRODUCTS-COMP/OP AGG --—___ <br /> OTHER: Aggregate $5,000,000 j Abuse and Molestation $ 500,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident) <br /> A ALL OWNED SCHEDULED - BODILY INJURY(Pwpsrson) S <br /> ANY AUTO i <br /> KR00000007170900 12/31/2017 12/31/2018 <br /> BODILY INJURY(Per atxWent) $ _ <br /> AUTOS __ AUTOS i - —�-- - <br /> NON-OWNED PROPERTY DAMAGE <br /> X X 12:01 AM 12:01 AN: Per accident) __ $ <br /> HIRED AUTOS AUTOS - -(-- -----} _ , <br /> $ <br /> f <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> 71 EXCESS LIAR CLAIMS-MADE I AGGREGATE i ;$ <br /> I !DED RETENTION S $ <br /> l WORKERS COMPENSATION PER - <br /> IAND EMPLOYERS'LIABILITY STATUTE <br /> N/A _ <br /> Y/NI <br /> ,ANY PROPRIETOR/PARTNER/EXECUTIVE i I E.L.EACH ACCIDENT $ <br /> >OFFICERIMEMBER EXCLUDED. <br /> '(Mandatory in NH) f E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe OF OPERATIONS below E.L.DIunder I` <br /> DESCRIPTION SEASE-POLICY LIMIT $ <br /> B JExcess Medical S Accident SPX0000028554500 12/31/2017 12/31/2018 Excess Medical $10,000 <br /> ; ($250 Deductible/Claim) 12:01 AM 12:01 AM AD 8 Specific Loss $2,500 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS TO THEIR INTEREST IN THE OPERATIONS OF <br /> THE NAMED INSURED. DATE OF EVENT(S) : 09/16/18 29th Annual Shoreline Classic INSURED RRCA <br /> CLUB/EVENT MEMBER: Decatur Running Club, Att'n: John Pranschke, PO Box 3397, Decatur, IL 62524 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 09/16/18 City of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1 Gary K <br /> Anderson Plaza <br /> Decatur, IL 62523 AUTHORIZED REPRESENTATIVE <br /> Terry Diller/MMA `F-Z - '�D`PS`e-tc PG U <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br /> INS025(201401) <br />