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

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,- -_--- ------ -_-- .---------.__—._-_-_..----- . ..-___----..____._- �. _ ------ PRINT DATE:;4/20/2017 CERTIFICATE OF INSURANCE CERTIFICATE NUMBER: 20170420512436 AGENCY: i ESIX,a division of Integro USA Inc. j 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.NAIC#:18058 Delm Springico ngs CO 80919-2401 Drive Colorado Springs ! INSURER B:Philadelphia Indemnity Ins.Co.MAIC#:18058 Colo � __ _.INFORMATION: _--._.. .............___ __...._._._ .. -... ..__.. EVENT Decatur Lakeside Triathlon(71812017-7/912017) POLICYICOVERAGE 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 PHPK1579791 1211/2016 12/1/2017 GENERAL AGGREGATE(Applies Per Event) $2,000,000 c - - 12:01 AM 12:01 AM _.-—_-.._. X Participant Legal Liability EACH OCCURRENCE $1,000,000 1 DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000 _. -----------------_- __. ..._. .... .... MEDICAL EXPENSE(Any one person) EXCLUDED PERSONAL&ADV INJURY $1,000,000 j ; E PRODUCTS-COMP/OP AGG $2,000,000 ' B UMBRELLAIEXCESS LIABILITY PHUB564242 12/1/2016 12/1/2017 X Occurrence I EACH OCCURRENCE $10,000,000 12:01 AM 12:01 AM —.___..............._ .._....._-. ... .. _.. _..__. AGGREGATE(Applies Per Event) $10,000,000 DESCRIPTION OF OPERATIONSfLOCATiONSIVEHICLES/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 per form PI-AM-002:Additional Insured-Certificate Holders. The General Liability policy is primary as per Form CG0001(04/13), The General Liability policy contains Form CG2404(05109):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. f i I ! i CERTIFICATE HOLDER: NOTICE OF CANCELLATION: � Illinois Department of Transportation Should any of the above described policies be cancelled before the expiration date thereof, 2300 S.Dirksan Parkway notice will be delivered in accordance with the policy provisions. Springfield IL 62764 lAUTHORIZED REPRESENTATIVE: i