R2017-64 Temporary Closing of State Rights-of-way Decatur Lakeside Triathlon

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PRINT DATE: 4/20/2017 CERTIFICATE OF INSURANCE I j CERTIFICATE NUMBER:�'20170420512434 AGENCY -- ESIX,a division of Integro USA Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND d/b/a Integro Insurance Brokers CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES . 2727 Paces Ferry Road,Building Two,Suite 1500 NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW' Atlanta,GA 30339 678-324-3300(Phone),678-324-3303(Fax) NAMED INSURED: INSURERS AFFORDING COVERAGE: USA Triathlon of Colorado Gene Mueller INSURER A:Philadelphia Indemnity Ins.Co.MAIC#:18058 5825 Delmonico Drive Colorado Springs CO 80919-2401 i INSURER B:Philadelphia Indemnity Ins.Co.NAIC#:18058 EVENT INFORMATION: Decatur Lakeside Triathlon(7/8/2017-7/9/2017) 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 X Occurrence PHPKIS79791 12/1/2016 12/1/2017 j 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/EXCESS LIABILITY X Occurrence PHUB564242 1211/2016 12/1/2017 EACH OCCURRENCE $10,000,000 12:01 AM ;12:01 AM ..-.--- AGGREGATE(Applies Per Event) $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/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 perform PI-AM-002:Additional Insured-Certificate Hollers. The General Liability policy is primary as per Form CG0001(04/13). i The General Liability policy contains Form CG2404(05/09):Waiver of Transfer of Rights of Recovery Against Others to US,but only as required by written contract or agreement executed by the named insured prior to an occurrence resulting in a loss or a claim. CERTIFICATE HOLDER: NOTICE OF CANCELLATION: City of Decatur Should any of the above described policies be cancelled before the expiration date thereof, #1 Gary Anderson Plaza notice will be delivered in accordance with the policy provisions.—�-- — — Decatur IL 62523 AUTHORIZED REPRESENTATIVE: � C