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HomeMy WebLinkAboutInsurance Certificate: Road Runners Club a►cofz CERTIFICATE OF LIABILITY INSURANCE 10/15/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ONTACT Judy Weaver STAR Insurance - Fort Wayne Office PHONE (260) 467-5697 FAC io. (250) 461-5651 2130 East DuPont Road EADDR-MAIL E S: INSURERS AFFORDING COVERAGE NAIC0 Fort Wayne IN 46825 INSURER ANational Casula Company 11991 INSURED INSURERS Nationwide Life Insurance Co. 66869 Road Runners Club of America/2012 S INSURERC: Its Member Clubs INSURER D: 1501 Lee Highway, Suite 140 INSURER E: Arlington VA 22209 INSURER F: COVERAGES CERTIFICATE NUMBER:2012 - $1M A. 1. REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A POLICY NUMBER PODCYEFF MMJDDY LIMITS R GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AEMI 5 Ea $ 500,000 occuiencei A CLAIMSMADE OCCUR X RED, 000000 2210800 2/31/2011 2/31/2012 MED EXP (Any mePe. $ 5,000 X Legal Liab. to Partic. 12:01 A.H. 2:01 A.M. PERSONALAADVIWURY $ 1,000,000 $1,000,000 GENERAL AGGREGATE $ NONE GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 1,000,000 X POLICY PR0. LOG LH AGGREGATE $5,000,000 ABUSE B MOLESTATION $ 500,000 AUTOMOBILE LABILITY aaBN~ED SINGLE LIMIT 1,000,000 A ANY AUTO BODILY INJURY (Per Person) $ ALLOWNED SCHEDULED X O 000000 2210800 2/31/2011 2/31/2012 BODILY INJURY(Feraccident) S AUTOS AUTOS NONMED 2:01 A-M. 2:01 A.M. PROPERTY DAMAGE X HIRED AIJr05 X AUTOS er accident $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE E DED RETENFIONS $ WORXERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS' LABILITY YIN ANY PROPRIE CRrPARTNER/EXECUTIVE EL EACH ACCIDENT S OFFICER,MEMBER EXCLUDED? ❑ N I A (MandmarYm NH) EL DISEASE - EA EMPLOYE S If yyes, desafte undc DESGRIPTIONOFOPERATIONSbelOe EL DISEASE - POLICY LIMIT $ B EXCESS MEDICAL 6 ACCIDENT X SPX 00000 25293800 2/31/2011 2/31/2012 EXCESSMEUCAL $10,000 ($250 DEDUCTIBLE/CLAIM) 2:01 A.H. 2:01 A-M. AD A SPECIFIC LOSS $2,500 DESCMPnON OF OPERATMNS I LDCAnONS I VEHICLES (ABach ACORD 101, AddMarul Remarks schedule, if mere space is required) City of Ashland, its agents and employees are NAMED AS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. - DATE OF EVENT: 11/03/12 Lithia Loop Trail Marathon INSURED CLUB: Rogue Valley Runners, attn: Hal Koerner; 161 E. Main Street, Ashland, OR 97520 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 11/03/12 City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATINE John Lefever/JWE ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 vnimmo, Th. ACr1Rn ..~mn cnd Irmo vn rnnicfernd mnr4e of ArnRn