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ACo® CERTIFICATE OF LIABILITY INSURANCE 7DATE(MM/DD YYYY) <br /> �/ /11/2023 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Liz Painter <br /> NAME: <br /> Insurance Management Group PHONE (260)240-4792 FAX (260)240-4792 <br /> A/C No Ext: A/C,No): <br /> 12730 Coldwater Rd Ste 103 ADDRESS: (painter@insmgt.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Fort Wayne IN 46845 INSURERA: National Casualty Company 11991 <br /> INSURED INSURER B: Nationwide Life Insurance Company 66869 <br /> Road Runners Club of America/2023 and Its Member Clubs INSURER C: <br /> INSURER D: <br /> 1501 Langston Boulevard,Suite 140 INSURER E: <br /> Arlington VA 22209 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 2023$1M A.1. 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 I AUUL5UBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 500,000 <br /> X Legal Liability to MED EXP(Any one person) $ 5,000 <br /> A Participant$1,000,000 KR00000009332900 12/31/2022 12/31/2023 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 <br /> POLICY PRO PRODUCTS-COMP/OP AGO $ <br /> JECT ❑LOC 1,000,000 <br /> HX­ <br /> OTHER: For Event Basis Abuse and Molestation $ 500,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> A OWNED SCHEDULED KR00000009332900 12/31/2022 12/31/2023 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY IX <br /> AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> REXCESS LAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? F-7 NIA E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Excess Medical&Accident <br /> Excess Medical $10,000 <br /> B ($250 Deductible/Claim) BAX0000031991400 12/31/2022 12/31/2023 AD&Specific Loss $2,500 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> City of Decatur and Decatur Park District IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS TO THEIR INTEREST IN THE OPERATIONS OF THE <br /> NAMED INSURED. DATE OF EVENT(S):10/01/23 34th Annual Shoreline Classic INSURED RRCA CLUB/EVENT MEMBER:Decatur Running Club <br /> ATTN:John H Pranschke,2039 N 1525 EAST RD,Findlay IL 62534-4107 <br /> Processed by RMV <br /> Effective 07/14/23 this voids and replaces any previously issued certificates. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> 10/01/23 City of Decatur and Decatur Park District ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 620 East Riverside <br /> AUTHORIZED REPRESENTATIVE <br /> Decatur IL 62521 (�, J� t <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />