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� <br /> DATE:(3/31/2016 <br /> CERTIFICATE OF INSURANCE � <br /> CERTIFICATE NUMBER: 20160331410077 <br /> AGENCY: <br /> ESIX 3 lLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br /> d/b/a EnteRainment 8 Sports Insurance eXperts(ESIX) CONFERS NO RI�HTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES <br /> dJb/a Entertainment and Sports Insurar�ce Agency(Caiifomia) NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED BY 7HE POLICIES <br /> 2727 Paces Ferry Road,Building Two,Suite 1500 BELOW. <br /> AUanta,GA 30339 <br /> 67&3243300(Telephone) <br /> � 678-324-3303(Facsimile) <br /> NAMED INSURED: INSURERS AFFORDING COVERAGE: <br /> USA Triathlon of Colorado Gene Mueller �INSURER A: Everest Nationai insurance Compa�y <br /> 5825 Delmonico Drive E <br /> Cobrado Springs CO 809194401 INSURER B: Everest National insurance Company <br /> EVENT INFORMATION: <br /> 'Rodney T.Miller Lakeside Triathlon(7H 0/2016-7l10/2016) <br /> POLICY/COVERAGE INFORMATION: <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDINC,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 TNE TERMS, EXCLUSI4NS AND CONDITIONS OF SUCN POLICIES.AGGREGATE <br /> LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INS TYPE OF INSURANCE: I POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS: <br /> A GENERAL LIABILITY ^ <br /> SI8ML00212-151 12/1/2015 12/1/2016 <br /> X Oocurrence GENERAL AGGREGATE(Appiies Per Event) $2,000,000 <br /> 12:01 AM '12:01 AM <br /> X Partiapant Legal Liability EACH OCCURRENCE $1,000,000 <br /> ^ DAMAGE TO RENTED PREMISES(Each Ooc.) $1,000,000 <br /> MEDICAL EXPENSE(Any one person) EXCLUDED <br /> PERSONAI&ADV INJURY $1,000,000 <br /> PRODUCTS-COMP/0P AGG $2,000,000 <br /> B UMBRELWEXCESS LIABILITY <br /> � — S18EX00179-151 1211l2015 12/1/2016 <br /> X Oca�rrence 12;01 AM 12:01 AM ( �CH OCCURRENCE 510,000,000 <br /> AGGREGATE(Applies Per Event) $10,000,000 ` <br /> � I AGGREGATE(Policy) 540,000,000 <br /> DESCRtPTION OF OPERATIONSILOCATIONSNEHICLESfEXCLUSiONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: <br /> Coverage appiies to the USA Triathlon sanctioned or approved event specified on this certificate. <br /> The certificate holder is an additional insured as per fwm ECG20600:Additional Insured-Automatic Status When Required in a Written Agreemeni <br /> The General Liability policy fs primary as per Fortn 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 /> City of Decatu� Should any of the above described policies be pncelled before the erzpiration date thereof, <br /> #1 G8ry AndefSOn Plaza notice will be delNered in aocordance with the policy provisions. <br /> � Decatur IL 62523 AUTHORIZED REPRESENTATIVE: <br /> I <br /> � <br /> I � <br />