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A�'�� DATE(MM/DD/YYl^/) <br /> `� CERTIFICATE OF LIABILITY INSURANCE 5/9/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE7WEEN THE ISSUING INSURER�S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate hotder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditlons of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certiflcate holder in lieu of such endorsement(s). <br /> PROOUCER NAME:CT M�=gaLOt. M. Mayers <br /> STAR Insurance - Fort Wayne Office PHONE . (260)467-5689 aC No:(z60)467-5691 <br /> 2130 East Dupont Road 'MA�� mar aret.ma ers@starfinancial.com <br /> ADDRESS: g y <br /> INSURER S AFFORDING COVERAGE NAIC U <br /> Fort Wayne IN 46825 �NsuttertnNational Casualt Com an 11991 <br /> INSURED INSURERBNdti0IIwlde Life Insurance Co. 66869 <br /> Road Runners Club of America/2016 and Its iNsurs�Rc: <br /> Member Clubs INSURERD: <br /> 1501 Lee Highway, Suite 140 INSURERE: <br /> Arlington VA 22209 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER2oi 6 S iM A._. REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POIICY PERIOD <br /> IN�ICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHlCH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR POLICY EFF POLICY EXP <br /> �� TYPE Of INSURANCE POLICY NUMBER MIWDD MNVDDIYYYY LIMITS <br /> X COMMERCIAL GENERAL LIABIIJTY EACH OCCURRENCE S 1,000�000 <br /> A CLAIMS-MADE a OCCUR PREMISES Ea acanrence � 500,000 <br /> X Legal Liability to Iato0000005887400 12/31/2015 12/31/2016 MEDEXP(Anyoneperson) S 5,000 <br /> Participant $1,000,000 12:01 AM 12:01 AM pERSONALBADVINJURY S 1,000,000 <br /> GEN'L AGGREGATE lIM1T APPLIES PER: GENERAL AGGREGATE S Unlimited <br /> x POLICY❑�E a �LOC Abusa 6 Moleatation PRODUCTS-CAMP/OP AGG S 1,000�000 <br /> OTHER: �+ggregate 55,000,000 Abuse&Molesta6on S 500,000 <br /> AUTOMOBILE LIABILITY MBI E INGLE LIMIT S 1,000,000 <br /> Ea accident <br /> A ANY AUTO 80DIlY INJURY(Perperso�) S <br /> ALL OVvNED SCHEOULED �00000005887400 12/31/2015 12/31/2016 BODILY INJURY(Peracddent) S <br /> AUTOS AUTOS <br /> x HIRED AUTOS R NON-0WNED 12:01 AM 12:01 AM PROPERTY DAMAGE S <br /> AUTOS Per accident <br /> a <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE E <br /> E%CESS LIAB CLAIMS-MADE AGGREGATE S <br /> DED RETENTIONS S <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y�N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S <br /> OFFICER/MEMBER EXCLUDED7 ❑ NIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.l.DISEASE-POIICY LIMiT $ <br /> 8 Excess Medical 6 Accident sexo000027201500 12/31/2015 12/31/201fi ExcessMedical $10,000 <br /> ($250 Deductible/Claim) 12:01 AM 12:01 xM ADSSpecificLou $2,500 <br /> DESCRIPTION OF OPERATION5/LOCAT�ONS/VEH�C�ES(ACORD 101,Additional Remarks Schedule,may he aMached if more space is required) <br /> CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAI, INSIIRED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE <br /> NAMED INSIIRED. DATE OF EVENT(S) : 09/18/16 27th Annual Shoreline Classic INSIIRED RRCA <br /> CLLJB/EVENT ME2�ER: Decatur Running Club, Att`n: John Pranschke; PO Box 3397, Decatur, IL 62524 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 09/18/16 City of Decatur THE EXPIRATION DATE THEREOF, NOTiCE WILL BE DELIVERED IN <br /> 1 Gary K, Anderson PldZa ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Decatur, IL 62523 <br /> AUTHORIZED REPRESENTATIVE <br /> ..� <br /> Terry Diller/MMA '�-�'�-# R-.�-.QSL2��Pc�J <br /> O 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> INS025 r�mnnn <br />