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DATE: 2/1=015 <br /> CERTIFICATE OF INSURANCE <br /> CERTIFICATE NUMBER: 20150212315110 <br /> AGENCY: <br /> ESIX 3 LLC TI-#S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br /> d)Wa Entertainment&Sports Insurance eXperts(ESRC) CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES <br /> d!b/a Entertainment and Sports Insurance nee Agency(Cafifomia) NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> 2727 Paces Ferry Road,Building Two,Suite 1500 BELOW. <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 Inn canoe Company <br /> 5825 Del Sprico ngs CO80919-2401 Drive <br /> Springs INSURER B: Everest National Insurance Company <br /> EVENT INFORMATION: <br /> Rodney T.Miller Lakeside Triathlon(7/1212015-7/1212015) <br /> POLICY/COVERAGE INFORMATION: <br /> THE POLICIES OF INSURANCE LISTED BELOW 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 NUMBER(S): EFFECTIVE: EXPIRES: LITS: <br /> A GENERAL LIABILITY <br /> X Occurrence S18ML00212-141 12/1/2014 12/1/2015 GENERAL AGGREGATE(Applies Per Event) $2,OIm,000 <br /> 12:01 AM 12:01 AM <br /> X Participant Legal Liability EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED PREMISES(Each Oce.) $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 12/1!2014 12/1/2015 AGGREGATE $10,000,000 <br /> 12:01 AM 12:01 AM <br /> EACH OCCURRENCE $10,000,000 <br /> DESCRIPTION OF OPERATIONSJLOCA CLUSIONS ADDED BY ENDORSEMENIT/SPECUIL PROVISIONS: <br /> Coverage applies to the USA Triathlon sanctioned or approved event specified an this certificate. <br /> The certificate hok ler is an additional insured as per farrn ECG20600 Additional Insured-Automatic Status VNhen Required in a Witten Agreement. <br /> The General Liability policy is primary as per CG0001. <br /> The General Liability poficy contains a Waiver of Subrogation provision as required by written agreement per Form ECG24522. <br /> CERTIFICATE HOLDER: NOTICE OF CANCELLATION: <br /> City of Decatur Should any of the above described policies be cancelled before the expiraboo dale ttrere& <br /> #1 Gary Anderson Plaza notice wig be delivered in accordance with the policy provisions. <br /> Decatur IL 62523 AUTHORIZED REPRESENTATIVE: <br />