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Home My WebLink AboutInsurance Certificate: Oregon Bicycle Racing Association Certificate of.General Liability & Accident Medical Insurance DAT01/242013m PRODUCER Phone: (800) 747-9573 Fnv: (303) 422-1276 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Camp Teem ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 51135 Wadsworth Pkwy., Suite 3840 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Westminster, CO 80021 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED SpMS a,a Recraeaon ProNdara Assoc. (puchasing poop) aMib mw~en. INSURER A: United Slates Fire Ins. Co. Oregon Bicycle Racing Association INSURER B: United States Fire Ins. Co. P.O. Box 5773 INSURER C: _ Salem, OR 97304 INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOIIIREMENT, TERM OR CONDI T ON OF ANY CONTRACT OR OTHER DOCUMENT W ITH RESPECTTO 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 SHOW N MAY HAVE BEEN REDUCED BY PAID CLAMS. INSR ADDt TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION LIMRB LTR raao DATE(MLVDDIYY) DATE (MWDDIYY A GENERAL LIABILITY SRPGAPM-101-0312 01/18/2013 01116/2014 ACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY 1E DAMAGE (Any one Fns) 300,00D CLAMSMADE OCCUR ED. EXP(Spectanng Only) 5,000 A X ING ATHLETIC PARTICIPANTS ERSONAL B ADV PLLEY 1,000,000 3ENERALAGGREGATE 2,000,000 RODUCTSCOMP/OP AGG. 2,000,000 UTOMOBILE LIABILITY SRPGAPM-101-0312 01116/2013 01/16/2014 gINED SINGLE UMR $1,000,000 ANY AUTO Ea aoddent) ALLOWNEDAUTOS 30DILY INJURY $ A SCHEDULED AUTOS Par peson) X HIRED AUTOS X NON-OWNEDAUTOS ODILY INJURY Per accident) ROPERTY DAMAGE Per accident) ACCIDENT MEDICAL AXMUM MEDICAL BENEFIT 10,000 ER CLAIM CCIDENTAL DEATH 6 X Eraea To Pdma Health Ins. ~ ISMEMBERMENT 21500 B Policy veil not rover Primary health US074672 01116/2013 01/1612014 Inserence deGFades. co-pays. gogram /nits, or ea of neero^ care. X I iryued parry des nd have pdmary EDUCTIBLE PER CLAM 11000 wen, aces coverage eecanes - primary. EXCESS I UMBRELLA LIABILITY USX100154 01/18/2013 01116/2014 EACH OCCURRENCE $1,000,000 X OCCUR CLAIMS MADE - AGGREGATE 1,000,000 A DEDUCTIBLE RETENTION $ OTHER: ABUSE AND MOLESTATION SRPGAPM-101-0312 0111612013 01/16/2014 ACHOCCURRENCE $100,000 A ENERAL AGGREGATE $100,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTSISPECIAL PROVISIONS Bicycle Racing / Running / USA Additional Insured(s): Effective 112412013, Certificate holder(s) arefis added as additional insured in regards to the operations of the insured. CERTIFICATE HOLDER _ CANCELLATION _ Ashland Fire SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE E(PIiATION 455 siskiyou blvd DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 30 DAYS WRITTEN NOTICE Ashland Or. 97520 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE f~/`!/f4(`%~ Harold Laid Certificate of General Liability & Accident Medical Insurance 1 °AT 01242 3Y") PRODUCER Ph": (Boo) 747-9573 Fax (303)422.1276 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Camp Team ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9035 Wadsworth Pkwy., Suite 3840 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Westminster, CO 80021 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Sports wMRac O.n ProNmrs An..(I>R Ingaaw)andlb members. INSURER A: United States Fire Ins. Co. Oregon Bicycle Racing Association INSURER B: United States Fire In. Co. P.O. Box 5773 - INSURER C: Salem, OR 97304 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN BSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT W ITH RESPECTTO W HIGH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDMONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAMS. INSR A POLICY EFFECTIVE POLICY EXPIRATION Lm N6M TYPE OF INSURANCE POLICY NUMBER DATE (MINDD DALE M/DO/YY) LIMITS GENERAL LIMUTY SRPGAPM-101-0312 01/16/2013 01116/2014 CH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY RE DAMAGE (Any ons fire) 300,000 CLAMS MADE X OCCUR ED. EXP (Specfamns ONy) 5,000 A X ING ATHLETIC PARTICIPANTS ERSONAL B ADV INJURY 1,000,000 ENERAL AGGREGATE 2,000,000 ODUCTSCOMPIOP AGG. 2,000,000 OMOBILE LIABILITY SRPGAPWIOI-0312 0111612013 01/1612014 81NED SINGLE LIMIT 1,000,000 ANY AUTO Ea scddenl) ALL OWNED AUTOS 0DILY INJURY A SCHEDULED AUTOS Perpemon) X HIRED AUTOS X NON OWNED AUTOS LY INDURY per awbdenl ROPERTY DAMAGE Per accident) ACCIDENT MEDICAL AAXIMUNI MEDICAL BENEFIT 10,000 ERCLAIM X OCIDENTAL DEATH S 2,500 Erxass TO Pdm Health LTa BMEMBERMENT B PokywlanotcoTerpamarynsallh US074672 01!16!2013 01/1612014 insurance deductibles. co-pays, X lliprapam ar doesnN nehmrk care. EDUCTIBLE PER CLAM 1,000 hoed Pamy nt fannary care,ry. corerape Octanes primary. CESS I UMBRELLA LIABILITY USX100154 01116/2013 01/1612014 EACH OCCURRENCE '61,000,000 X OCCUR CLAMSMADE AGGREGATE ,000,000 A DEDUCTIBLE $ RETENTION $ HER: ABUSE AND MOLESTATION SRPGAPM-101-0312 01/1612013 011162014 CH OCCURRENCE $100,000 A ENERAL AGGREGATE $ 100,ODO DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS Bicycle Racing / Running / USA Additional Insured(s): Effective 1/24/2013, Certificate holder(s) ararm added as additional insured in regards to the operations of the insured. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 20 E. Main St DATE THEREOF, THE ISSUING NSURER W LLL ENDEAVOR TO MAL 30 DAYS WRITTEN NOTICE Ashland Or. 97520 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UAB LRY OF ANY HIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 7 HaroldLeid Certificate of General Liability & Accident Medical Insurance 1 DATE 01/25/2013m PRODUCER Phone: (800) 747-9573 I= (303) 422.1276 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Camp Team ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9035 Wadsworth Pkwy., Suite 3840 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Westminster, CO 80021 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Some VM Recreation Pmia Assoc.(PWrclmaing grow) end im rei+ M. INSURER A. United States Fire Ins. Co. Oregon Bicycle Racing Association INSURER B: United States Fire Ins Co. P.O. Box 5773 INSURER C: Salem, OR 97304 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT W ITH RESPECT TO W HICH 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 LMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. IHSR ADOL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PoLICY EXPIRATION LIMfIS Ln N5110 DATE(MWDDNY) DATE(MM/DOIYY) GENERAL LIABILITY SRPGAPLI-101-0312 0111612013 01/16/2014 ACH OCCURRENCE 1,000,000 X CCMMERCIAL GENERAL LIABILITY E DAMAGE (Any one Ike) 300,000 CLAIMS MADE X OCCUR ED. EXP ISPectalorb Only) 5,000 A X INC ATHLETIC PARTICIPANTS ERSONAL& ADV INJURY 1,000,000 - NERALAGGREGATE $ 2,000,000 RODUCTS-COMPIOP AGO- 2,OOD,000 UTOMOBILE UA13ILFTY- SRPGAPM-101-0312 01/16/2013 01/16/2014 BINED SINGE UNIT 1,000,000 ANY AUTO Ea weideM ALL OWNED AUTOS ODILV INJURY A SCHEDULEDAUTOS - Per pew) X HREDAUTOs X NMOWNEDAUTO.S ILYNNRV racci0ert ROPERTY DAMAGE Per aceMen6 ACCIDENT MEDICAL WAXIMUM MEDICAL BENEFIT 10,000 ER CLAM GCDENTAL DEATH& X 2,500 Excess To P' Health en. ISMEMSERMENT B Policy " ran cover primary health US074672 01/16/2013 01/16/2014 InwaanmdsdecllNes,c pays, X rynd" party does nor have pdmary EDUCTIBLE PER CLAM 1,000 Care, excess Coverage becarnes pdmary. DESS I UMBRELLA LIABILITY USX100154 01/16/2013 01/16/2014 EACH OCCURRENCE Ip1,000,000 X OCCUR CLAMS MADE GOREGATE 1,000,000 A DEDUCTIBLE RETENTION $ FHER: ABUSE AND MOLESTATION SRPGAPM-101-0312 01/1012013 01/162014 CH OCCURRENCE $100,000 A ENERAL AGGREGATE$ 100,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS Bicycle Racing / Running / USA Additional Insured(s): Effective 1125/2013, Certificate holder(s) ara(IB added as additional insured in regards to the operations of the insured. CERTIFICATE HOLDER CANCELLATION Rogue River-Siskyou National Forest SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 645 Washington SL DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE Ashland, OR 97520 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL MPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER, ITS AGENTS OR f REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - ~6ce/ 7 Harold Laid Certificate of General Liability & Accident Medical Insurance DAT0125/2013m PRODUCER Ptme: (BXX) 747-9573 Fax: (3X3) 422-1278 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION The Camp Team ONLY AND CONFERS NO RIGHTS UPON THE CER'RFICATE 9035 Wadsworth Pkwy., Suite 3840 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Westminster, CO 80021 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Spodeandllc lion Pmvidam Angie. (Pumhasin9 voup) andM mamhem. INSURER A: United States Fire Ins. Co. Oregon Bicycle Racing Association INSURER B: United States Fire Ins. Co. P.O. Box 5773 INSURER C: Salem, OR 97304 INSURER D: INSURER E: COVERAGES 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 ANYCONTRACT OR OTHER DOCUMENT W RH RESPECT Tn W HCH 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 POIK IES. AGGREGATE LMI7S SHOW N MAY HAVE BEEN REDUCED BY PAID CLAMS. IWR MM TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR r60 DATE DATE (MMMDfM GENERAL UABILm SRPGAPM-101-0312 01116/2013 01/1612014 ACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY -IRE DAMAGE (Any u em) 300,000 CLAMS MADE OCCUR X ED. E%P (SpecMmrs Only) 5,000 A X INCATHLEnc PARTICIPANTS ERSNAL 8 AUV INJURY 1,000,000 NERAL AGGREGATE 2,000,000 RODUCTSCOMPIOP AGO. 2,000,000 AUTOMOBILE LIABILITY SRPGAPM-101-0312 01/1612013 01/16/2014 CMBNED SINGLE LIMIT {1,000,000 eaddart) ANYAUTO Ea ALLOWNEDAUTOS 30DILY INJURY A SCHEDULED AUTO Per person) X HIREDAUTOS X NNOWNEDAUIOS ILY INJURY Per accWanL HOPERTY DAMAGE Per amiden0 ACCIDENTMEOICAL AXMUM MEDICAL BENEFIT { 10,000 ER CLAM CCIDENTAL DEATH 8 2'50 ISMENBERMENT X Excess TO Ptlm Neale, Yrs 0 B POIICYWlnmwrerpdmarynealm US074672 01/16/2013 0111612014 irmeeroe dama:hLlas, co-pan, program ftft' m Der of neevax e X r in)ved parry dan nor have primary EDUCTIBLE PER CLAM 1,000 Cam, ex s c age Secann Pdmary. ESS I OMBRFI 1 A LIABILITY USX100154 01/16/2013 01116/2014 EACH OCCURRENCE {1,000;000 I X OCCUR CLAMS MADE AGGREGATE $1,000,000 A DEDUCTIBLE $ RETENTION $ A [ITHER, ABUSE AND MOLESTATION SRPGAPKIOI-0312 0111612013 01/16/2014 CHOCCURRENCE $100,000 ENERAL AGGREGATE $ 100,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS Bicycle Racing / Running / USA Additional Insured(s): Effective 1/2512013, Certificate holder(s) are/is added as additional insured in regards to the operations of the Insured. CERTIFICATE HOLDER _ CANCELLATION Andy Ernst SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1087 Cabot Blvd #6 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 30 DAYS WRITTEN NOTICE Hayward, CA 94545 NO OTHE BUGAR NON LIABILITY OF ANY KINUPON THE INSURER, ITS QED SHALL IMPOSE REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~Gf/fi~6:/~6rd, Harold Laid Certificate of General Liability & Accident Medical Insurance DAT0125/2013 YY) PRODUCER Phorre: (800) 747.9573 Fac (303) 422-1276 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Camp Team ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9035 Wadsworth Pkwy., Suite 3840 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Westminster, CO 80021 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Sports and Recreation Providms Assoc.(prdwiggaup) ardils nemw& INSURER A: United States Fire Ire-Co. Oregon Bicycle Racing Association INSURER B: United States Fire Ins. Co. P.O. Box 5773 INSURER C: Salem, OR 97304 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW rrHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENTWITH RESPECT TOWHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. AGGREGATE LMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAMS. IWR amt TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIbY1S LIP Taro DATE (MWDD/YY) DATE (MM/DD GENERAL LIABILITY SRPGAPM-101-0312 01116/2013 01/16/2014 EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABLITY - RE DAMAGE (Any one fire) 300,000 CLAMS MADE OCCUR ED. EXP (Spectators Only) 5,000 A X INC ATHLETIC PARTICIPANTS ERSONAL 6 ADV INJURY 1,000,000 NERAL AGGREGATE 2,000,000 RODUCTS-COMP/OP AGG. 2,000,000 OMOfaLE LIABILITY SRPGAPM-101-0312 0111812013 011162014 ,OMSINEDSINGUELIMR ,$1,000,000 ANYAUTO Ea accident) ALLOWNEDAUTOS 3000-Y $ A SCHEDULEDAUTOS Per person) X HIRED AUTOS X NONOWNEDAUTOS Per molders) ROPERTY DAMAGE Per accident) ACCIDENT MEDICAL AXMUM MEDICAL BENEFIT ER CLAM $10,000 CCDENTAL DEATH A X Excess To Pren Hearin Inc. SMEMBERMENT 2.500 B Policy Will not cover primary nearin US074672 01/16/2013 01/1612014 Insurance deductlMSa. copays, X propran Innis, or out of neMWk Cora EWCTSLE PER CLAM 1,000 8 injured Parry does not have prlnarY care, excess coverage eecomes Primary. XCESS/UMBRELLA LIABILITY USX100154 01/16/2013 01/16/2014 EACH OCCURRENCE ($1,000,000 X OCCUR CIAMS MADE AGGREGATE $1,000,000 A DEDUCTIBLE RETENTIONS HER: ABUSE AND MOLESTATION SRPGAPM-101-0312 01/1(12013 O7/1612014 CHOGGURRENCE $100,000 A GENERAL AGGREGATE $ 100,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTSISPECIAL PROVISIONS Bicycle Racing / Running / USA Add'N'onal Insured(s): Effective 1/25/2013, Certificate holder(s) arels added as additional insured in regards to the operations of the insured. CERTIFICATE HOLDER CANCELLATION Kenneth Palen SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 2665 Alvarado Terrace DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE Salem, OR 97302 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Harold Laid Certificate of General Liability & Accident Medical Insurance DAT01(MhVDDNY 25/203rn PRODUCER Phone: (eDO) 747-9573 Fax (303) 422.1276 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Camp Team ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9035 Wadsworth Pkwy., Suite 3840 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Westminster, CO 80021 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED So" and Rwation ProWdara Assoc. (N chasing gaup) andits mm b..- INSURER A: United Slates Fire Ins. Co. Oregon Bicycle Racing Association INSURER B: United Slates Fire Ins. Co. P.O. Box 5773 INSURER C: Salem, OR 97304 - INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOIIREMENT, TERM OR CONDITION OF ANYCONRWCT OR OTHER DOCUMENT W ITH RESPECT TO W HCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR omL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LI~s, LTR ISO DATE(MWDDN-f) DATE(MILDDIYY) GENERAL LIABILITY . SRPGAPWIOI-0312 01/18/2013 01/16/2014 CH OCCURRENCE '61,000,000 X COMMERCIAL GENERAL LIABILITY RE DAMAGE (Any one fire) 300,000 CLAIMS MADE X OCCUR ED. EXP (Spntamrc Only) 5,000 A X INC ATHLEriCPARTiciPANT3 ERSONAL 6 ADV INJURY 1,000,000 ENERAL AGGREGATE 2,000,000 ODUCTS-COMP/OP AGG. 2,000,000 AUTOMOBILE LIABILITY SRPGAPM-101-0312 01/16/2013 01/1612014 BNED SINGLE LIMIT $1,000,000 ANYAUTO Ea acdtlent) ALLOWNEDAUTOS 3ODLY INJURY A SCHEDULED AUTOS Per person) X H03EDAUTOS X NONOWNEDAUTOS 0DLY INJURY g aetlderd ROPERTY DAMAGE Per accident) ACCIDENT MEDICAL i AXIMUM MEDICAL BENEFIT ER CLAM $ 10,000 X CCIDENTAL DEATH 8 2500 Emeas To Primary Health Ins. SMEMaEAMFNT B Po0cyS ml cover primary health US074672 0111612013 0111612014 insurance deductibles, copays, program rsnlre, arom al neanodscare. X I Injured parry don rtm haw pdmmy I EDUCTIBLE PER CLAM 1,000 cane, 9mes3 oowrage boon nn Primary. CEBS/ UM BRELLALIABILTTY USX10D154 01/16/2013 0111612014 EACH OCCURRENCE 1,000,000 X OCCUR CLAMS MADE AGGREGATE 1,000,000 A DEDUCTIBLE RETENTION$ A FHER: ABUSE AND MOLESTATION SRPGAPM-101-0312 01/162013 01/1612014 CH OCCURRENCE $ 100,000 GENERAL AGGREGATE $ 100,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTSISPECIAL. PROVISIONS Bicycle Racing / Running / USA Additional Insured(s): Effective 1/252013, Cenftate holder(s) areAS added as additional insured in regards to the operations of the Insured. CERTIFICATE HOLDER CANCELLATION _ Thomas Rollins SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION 75 B St/910 Mary Jane Ave. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MALL 30 DAYS W RRTEN NOTICE Ashland, OR 97520 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFALURE TO DO SO SHALL IMPOSE NOOBLIGATION OR LIABLIYOF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTAT Harold Laid