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AC"R"® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 07/16/2024 <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 Tabitha Messersmith <br /> NAME: <br /> Insurance Management Group PHM' <br /> HM Ext): (800)272-8673 FAX <br /> (AICNo: (765)664-0761 <br /> 959 East 4th St ADDRESS: tmessersmith@insmgt.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Marion IN 46952 INSURERA: Granite State Insurance Company 23809 <br /> INSURED INSURER B: National Union Fire Insurance Company of Pittsburgh,PA 19445 <br /> Road Runners Club of America/2024 and Its Member Clubs INSURER C: <br /> INSURER D: <br /> 100 W Jefferson St,Suite 202 INSURER E: <br /> Falls Church VA 22046 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 2024$1MA.1.Liability 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 CONTRACTOR 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 AUDLISUBRI POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY 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 AIL0003450335100 12/31/2023 12/31/2024 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 <br /> POLICY F1 PES [ LOC 1,000,000 <br /> PRODUCTS-COMP/OP AGG $ <br /> X 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 /> AOWNED SCHEDULED AIL0003450335100 12/31/2023 12/31/2024 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> IX <br /> HIRED �/ NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY /� AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION 77FPER OTH- <br /> AND EMPLOYERS'LIABILITY y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ <br /> OFFICER/MEMBER EXCLUDED? N/A 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) AID0003450335800 12/31/2023 12/31/2024 AD&Specific Loss $2,500 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> City of Decatur,IL IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS TO THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. <br /> DATE OF EVENT(S): 10/06/24 Shoreline Classic 5k/15k INSURED RRCA CLUB/EVENT MEMBER:Decatur Running Club ATTN:Scott Strompolis, <br /> P.O.Box 3397,Decatur IL 62524 <br /> Processed by RMV <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 /> 10/06/24 City of Decatur,IL ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 2850 N Jasper St <br /> AUTHORIZED REPRESENTATIVE <br /> Decatur IL 62526 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />