Laserfiche WebLink
DATE: 2/12/1015 <br /> CERTIFICATE OF INSURANCE <br /> CERTIFICATE NUMBER: 201SWI2315112 <br /> AGENCY: <br /> ESIX 3 LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br /> drda Entertainment&Sports Insurance experts(ESIX) CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES <br /> dlbla Entertainment and Sports Insurance Agency(Ca ffornia) NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> 2727 Paces Ferry Road,Budding Two,Suite 1500 BELOW. <br /> Atlanta,GA 30339 <br /> 678-324-3300(Telephone) <br /> 676.324-3303(Facsimle) <br /> NAMED INSURED: INSURERS AFFORDING COVERAGE: <br /> USA Triathlon of Colorado Gene Mueller INSURER A. Everest National Insurance Company <br /> 5825 Delmonico Drive <br /> Colorado Springs CO 80919-2401 INSURER B: Everest National Insurance Company <br /> EVENT INFORMATION: <br /> Rodney T.Miler Lakeside Triathlon(7/122015-7/12/2015) <br /> POLICYICOVERAGE INFORMATION: <br /> THE POLICIES OF INSURANCE LISTED SOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING 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: POLICY NUMBEKS): EFFECTIVE: EXPIRES: LIMITS: <br /> A GENERAL LIABILITY <br /> X Occurrence S18MLOO212-141 12/12014 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.) $1,000,000 <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 S18EX00179-141 12/12014 12/1/2015 AGGREGATE $10,000,000 <br /> 12:01 AM 12.01 AM <br /> EACH OCCURRENCE $10,000,000 <br /> DESCRIPTION OF OPERATIONSfLOCATIONS/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 ECG20600:Additional Insured-Automatic Stats When Required in a Written Agreement. <br /> The General Liability policy is primary as per C00001. <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 /> State of Illinois Department of Transportation ShorAd any of the above dewed poicie 1 be canceled before the mWiration date thereof. <br /> 2300 S.Dirkson Pkwy notice will be ddwred in a cwft oe with the policy provisions. <br /> Springfield IL 62764 AUTHOFJZED REPRESENTATIVE: <br />