R2014-65 REGARDING TEMPORARY CLOSING OF STATE RIGHTS-OF-WAY

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CERTIFICATE OF INSURANCE DATE: 5/15/2014 CERTIFICATE NUMBER: 20140515246929 AGENCY: ESIX Entertainment&Sports Insurance eXperts THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 5660 New Northside Drive,Suite 640 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES Atlanta,GA 30328 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES Phone:(678)324-3300 Fax:(678)324-3303 BELOW. NAMED INSURED: INSURERS AFFORDING COVERAGE: USA Triathlon of Colorado Gene Mueller INSURER A: AXIS Insurance Company NAIC#37273 5825 Delmonico Drive P Y( ) Colorado Springs CO 80919-2401 INSURER B: AXIS Insurance Company(NAIC#37273) EVENT INFORMATION: Rodney T.Miller Lakeside Triathlon(7/12/2014-7/13/2014) POLICY/COVERAGE INFORMATION: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS TYPE OF INSURANCE: POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS: A GENERAL LIABILITY i X Occurrence AXGL06100260-13 12/1/2013 12/1/2014 GENERAL AGGREGATE(Applies Per Event) $2,000,000 — 12:01 AM 12:01 AM X Participant Legal Liability EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000 MEDICAL EXPENSE(Any one person) EXCLUDED PERSONAL&ADV INJURY $1,000,000 PRODUCTS-COMP/OP AGG $2,000,000 B UMBRELLA/EXCESSLIABILITY X Occurrence AXXS05100446-13 12/1/2013 12/1/2014 12:01 AM 12:01 AM AGGREGATE(Applies Per Event) $10,000,000 EACH OCCURRENCE $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Coverage applies to the USA Triathlon sanctioned or approved event specified on this certificate. The certificate holder is an additional insured as required by written contract or written agreement, but only for liability arising out of the negligence of the Named Insureds. The General Liability policy is primary and non-contributory with respect to the negligence of the Named Insureds(Form CG 00 01). The General Liability policy contains a blanket Waiver of Subrogation as required by contract per Waiver of Transfer of Rights of Recovery Against Others(Form CG 2404). I CERTIFICATE HOLDER: NOTICE OF CANCELLATION: State of Illinois Department of Transportation Should any of the above described policies be cancelled before the expiration date thereof, 2300 S.Dirkson Pkwy notice will be delivered in accordance with the policy provisions. Springfield IL 62764 AUTHORIZED REPRESENTATIVE: v / I i