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DATE: 4/25/2013 <br /> CERTIFICATE OF INSURANCE ------ - ----� <br /> CERTIFICATE NUMBER: 20130425145761 <br /> (AGENCY: _ <br /> ESIX Entertainment&Sports Insurance eXperts THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br /> 5660 New Northside Drive,Suite 640 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES <br /> Atlanta,GA 30328 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. <br /> Phone:(678)324-3300 Fax:(678)324-3303 <br /> NAMED INSURED: INSURERS AFFORDING COVERAGE: <br /> USA Triathlon Gene Mueller INSURER A: AXIS Insurance Company(NAIC#37273) <br /> 5825 Delmonico Drive <br /> Colorado Springs CO 80919-2401 <br /> EVENT INFORMATION: <br /> RTM Lakeside Triathlon Open Water Swim Clinic(7/6/2013-7/6/2013) -- <br /> POLICY/COVERAGE INFORMATION: <br /> I 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 /> IN—STYPE OF INSURANCE: POLICY NUMBER(S): EFFECTIVE: I EXPIRES: LIMITS: <br /> A ;GENERAL LIABILITY <br /> X Occurrence AXGL05100260-12 12/1/2012 12/1/2013 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 /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS: <br /> 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 ' <br /> insured, but only with respect to the USAT sanctioned or approved event specified on this certificate per the following endorsement:Additional Insured-Designated <br /> Person or Organization-Written Contract or Written Agreement(Form AXIS1006). <br /> i <br /> '1 <br /> I <br /> I <br /> CERTIFICATE HOLDER: NOTICE OF CANCELLATION: ®� <br /> City of Decatur Should any of the above described policies be cancelled before the expiration date thereof, j <br /> #1 Gary Anderson Plaza notice will be delivered in accordance with the policy provisions. <br /> Decatur IL 62523 AUTHORIZED REPRESENTATIVE: j <br /> t <br /> ...........—...... - <br />