R2014-103 TEMPORARY CLOSING OF STATE RIGHTS-OF-WAY

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DATE(MMIDDIYYYY) ACO CERTIFICATE OF LIABILITY INSURANCE 8/8/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Judy Weaver STAR Insurance - Fort Wayne Office IA PHONE (2 60)467-5697 FA/C o: (260)467-5651 EMAIL DRSS• y ud weaver@starfinancial.com 2130 East Dupont Road ADE INSURERS AFFORDING COVERAGE NAIC# Fort Wayne IN 46825 INSURERANational Casualty Company 11991 INSURED INSURERB Nationwide Life Insurance Co. 66869 Road Runners Club of America/2014 and Its INSURER C: Member Clubs INSURER D 1501 Lee Highway, Suite 140 INSURERE: Pslington VP_ 22209 INSURERF: COVERAGES CERTIFICATE NUMBER 2014 - $1M A.I. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LTR ODD GENERAL LIABILITY EACH OCCURRENCE 5. 1,000, DAMAGE TO RENTED 500,000 $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence ACLAIMS-MADE OCCUR O 000000 3937500 2/31/2013 2/31/2014 MED EXP(Any one person) 5 5,000 2:01 A.M. 2:01 A.M. PERSONAL&ADV INJURY 5 1,000,000 X Legal Liability to GENERAL AGGREGATE 5 UNLIMITED Participant $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER use 5 Molestation PRODUCTS-COMP/OP AGG 5 1,000,000 PRO- ate $5,000,000 ABUSE&MOLESTATION 5 500,000 X POLICY LOC Aggregate COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident 5 1,000,000 BODILY INJURY(Per person) S A ANY AUTO ALL OWNED SCHEDULED KRo 000000 3937500 2/31/2013 2/31/2014 BODILY INJURY(Per accident) 5 AUTOS AUTOSPROPERTY DAMAGE X X NON-OWNED 2:01 A.M. 2:01 A.M. per accident 5 HIRED AUTOS AUTOS 5 UMBRELLA LIAR HOCCUR EACH OCCURRENCE 5 5 EXCESS LIAB CLAIMS-MADE AGGREGATE 5 DED RETENTION 5 WC STATU- OTH- WORKERS COMPENSATIONLIM TS AND EMPLOYERS'LIABILITY YIN El EACH ACCIDENT 5 ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N I A OFFICER/MEMBER EXCLUDED? El DISEASE-EA EMPLOYE 5 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS below B EXCESS MEDICAL & ACCIDENT PY. 00000 26139600 2/31/2013 2/31/2014 EXCESS MEDICAL $10,000 2:01 A.M. 12:01 A.M. AD&SPECIFIC LOSS $2,500 ($250 DEDUCTIBLE/CLAIM) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) City of Decatur and The State of Illinois are NAMED AS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. SPECIFICALLY FOR PORTION OF PREMISES USED FOR LISTED EVENT. DATE OF EVENT: 09/21/14 Shoreline Classic 2014 INSURED CLUB/EVENT MEMBER: Decatur Running Club, Att'n: John Pranschke, PO Box 3397, Decatur, IL 62524 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 09/21/14 City of Decatur, IL State Of Illinois AUTHORIZED REPRESENTATIVE #1 Gary K Anderson Plaza Decatur, IL 62523 John Lefever/MMA ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INCr19r i�mnn5)m The Ar npin name anri Innn aro ronictorcri mar4c of Ar'r1Rr)