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DATE: 2/122015 <br /> CERTIFICATE OF INSURANCE <br /> CERTIFICATE NUMBER: 20150212315111 <br /> AGENCY: <br /> ESIX 3 LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br /> dlbla Entertainment&Sports Insurance eXperts(ESIX) CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES <br /> d/b/a Entertainment and Sports Insurance Agency(California) 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: INSLIRERS AFFORDING COVERAGE: <br /> USA Triathlon of Colorado Gene Weller <br /> 5825 Delmonico,Drive INSURER A Everest Natiorrai Msuartoe Company <br /> Colorado Springs CO 80919-2401 INSURER B: Everest National Instrance Company <br /> EVENT INFORMATION: <br /> Rodney T.Miller Lakeside Triafhlan(7/12/2(115-7/122015) <br /> POLICY/COVERAGE INFORMATION: <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE)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: LMpTS: <br /> A GENERAL LIABILITY <br /> S18ML00212-141 12/12014 1211r2015 X 12:01 AM 12:01 AM GENERAL AGGREGATE(Applies Per Event) 52 000,000 <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 SISEX00179-141 12/12014 12/12015 AGGREGATE $10,000,000 <br /> 12:01 AM 12:01 AM <br /> EACH OCCURRENCE $10,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCA CLUSIONS ADDED BY ENDORSEMENTISPECIAL 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 Status When Required in a Witten Agreement. <br /> The General Liability policy is primary as per CG0001. <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 /> Decade Park District Should any of the above desaibed poldes be carrc A before the emirabam date thereof, <br /> 620 E.Riverside Ave. notice will be delivered im aceordwm with the policy promioms. <br /> 62521 IL 62521 AUTHORIZED REPRESENTATIVE. <br /> r' <br />