R2022-124 Resolution Regarding Temporary Closing of State Rights-of-Way Community Events - Shoreline Classic

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® DATE(MM/ Y) CERTIFICATE OF LIABILITY INSURANCE o2/1s/2022zozz 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 have ADDITIONAL INSURED provisions or 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 Margaret Mayers NAME: Insurance Management Group AICNN. Ext): (260)338-2925 AIC X.N.: (765)664-0761 12730 Coldwater Road,Suite 103 EMAIL mmayers@insmgt.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC k Fort Wayne IN 46845 INSURER A: National Casualty Company 11991 INSURED INSURER B: Nationwide Life Insurance Company 66869 Road Runners Club ofAmerica/2022 and Its Member Clubs INSURER C: INSURER D: 1501 Langston Boulevard,Suite 140 INSURER E: Arlington VA 22209 INSURER F: COVERAGES CERTIFICATE NUMBER: 2022$1MA.1. REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. TPuLiUY EFF POLICY EXP R TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS X COMMERCU\L GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7 OCCUR PREMISESI Ea occurrences $ 500,000 X Legal Liability to MED EXP(Anyone Denson) $ 5,000 A Participant$1,000,000 KR000000O8971200 12/31/2021 12/31/2022 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY❑PEo- F7LOC PRODUCTS-COMPIOPAGG $ 1,000,000 X OTHER: Per Event Basis Abuse and Molestation s 500,000 AUTOMOBILE LIABILITY COEa aMBINEccident D SINGLE LIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ AOWNED SCHEDULED KR00000008971200 12/31/2021 12/31/2022 BODILY INJURY(per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S IX AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION SS WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Excess Medical $10,000 Excess Medical&Accident B ($250 Deductible/Claim) BAX0000031850400 12/31/2021 12/31/2022 AD&Specific Loss $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I 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):10/02122 33rd Annual Shoreline Classic INSURED RRCA CLUB/EVENT MEMBER: Decatur Running Club,Att'n: John Pranschke,PO Box 3397,Decatur,IL 62524 Processed by MMM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10/02/22 City of Decatur ACCORDANCE WITH THE POLICY PROVISIONS. 1 Gary K AUTHORIZED REPRESENTATIVE Anderson Plaza N 1 Decatur IL 62523 c( �• 1� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD