Laserfiche WebLink
DATE::2/1=015 <br /> CERTIFICATE OF INSURANCE <br /> CERTIFICATE NUMBER: 20150212315110 <br /> AGENCY: <br /> 3 LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br /> ESIX <br /> ESIXEntertainment&Sports Insurance eXperts(ESIX) CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES <br /> d/blad/b/a Entertainment and Sports Insurance Agency(California) BEON.LOEND, EXTEND OR ALTEP.THE COVERAG AFFORDED BY THE POLICIES <br /> 2727 Paces Ferry Road,Building Two,Suite 1500 <br /> Atlanta,GA 30339 <br /> 678-324-3300(Telephone) <br /> 678-324-3303(Facsimile) <br /> NAMED INSURED: !INSURERS AFFORDING COVERAGE: <br /> USA Triathlon of Colorado Gene Mueller INSURER A Everest National insurance Company <br /> 5825 Delmonico Drive INSURER B: Everest National Insurance Company <br /> Colorado Springs CO 80919-2401 <br /> i EVENT INFORMATION: <br /> Rodney T.Miller Lakeside Triathlon(7/1212015-7/12/2015) <br /> POLICY/COVERAGE INFORMATION: <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTVATHSTANDING ANY <br /> REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE <br /> INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE <br /> LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- <br /> INS'TYPE OF INSURANCE: i POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS: <br /> A GENERAL LIABILITY <br /> X Occurrence SIBML00212-141 12/1/2014 12/12015 GENERAL AGGREGATE(Applies Per Event) $2,000,000 <br /> 12:01 AM 12:01 AM <br /> X Participant Legal Liability EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,900 <br /> MEDICAL EXPENSE(Any one person) EXCLUDED <br /> PERSONAL&ADV INJURY $1,000,000 <br /> PRODUCTS-COMP/OP AGG� $2,000,000 <br /> B !UMBRELLA/EXCESS LIABILITY <br /> X Occurrence SIBEX00179-141 12/12014 12112015 AGGREGATE $10,000,000 <br /> Occurrence <br /> --- 12:01 AM 12:01 AM - --– —EACH OCCURRENCE $10,000,000 <br /> DESCRIPTIONO.F OPER ATION SIL OCAT IONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: <br /> Coverage applies to the USA Triathlon sanctioned or approved event specified on this certificate. <br /> The certificate holder is an additional insured as per form ECG2D600:Additional insured-Automatic Status When Required in a Written Agreement <br /> The General Liability policy is primary as per CGOD01. <br /> The General Liability policy contains a Waiver of Subrogation provision as required by written agreement per Form ECG24522. <br /> CERTIFICATE HOLDER: !NOTICE OF CANCELLATION: <br /> Ci of Decatur Should any of the above described policies be cancelled before the e)iration date thereof, <br /> City notice will be delivered in accordance with the policy provisions. <br /> #1 Gary Anderson Plaza <br /> Decatur IL 62523 AUTHORIZED REPRESENTATIVE: <br /> r-- <br />