HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Association (2)
DATE (MWDD/YVYY)
Certificate of General Liability & Accident- Medical Insurance 01/24/2013
PRODUCER Phone: (800) 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 Sporn and Recmauon Promders Asses. (Purchasing woure and its members. 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 ANY CONTRACTOR OTHER DOCUMENT W nH 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AWL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR eSm DATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL LIABILITY SRPGAPM-101-0312 01/16/2013 01/16/2014 EACH OCCURRENCE 1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) 11 300,000
CLAIMS MADE X OCCUR MED. EXP (Spectators Only) 5,000
A X INC ATHLETIC PARTICIPANTS PERSONAL 8 ADV INJURY 1,000,000
ENERAL AGGREGATE 2,000,000
PRODUCTS-COMP/OP AGG. li~ 2,000,000
AUTOMOBILE LIABILITY SRPGAPM-101-0312 01116/2013 01/1612014 OMSINED SINGLE LIMIT $ 1,000,000
ANY AUTO Ea accident)
ALL OWNED AUTOS 0DILY INJURY
A SCHEDULED AUTOS Per person)
X HIRED AUTOS
X NON-OWNEDAUTOS INJURY
Per r accident)
ROPERTY DAMAGE
Per accident)
ACCIDENT MEDICAL AXIMUM MEDICAL BENEFIT
ER CLAIM 10,000
CCIDENTAL DEATH 8
X Excess To Prima Health Ins. DISMEMBERMENT 2,500
B Policy will not cover primary health US074672 01/16/2013 01/16/2014
insurance deductibles, co-pays,
program limits, or out of network care.
X 9 injured party does not have Primary DEDUCTIBLE PER CLAIM 1,000
care, excess coverage becomes
primary.
EXCESS/ UMBRELLA LIABILITY USX100154 01/16/2013 01/16/2014 EACH OCCURRENCE 1,000,000
X OCCUR CLAIMS MADE AGGREGATE 1,000,000
A
DEDUCTIBLE
RETENTION $
THER: ABUSE AND MOLESTATION SRPGAPM-101-0312 01116/2013 01/16/2014 EACH OCCURRENCE $ 100,000
A GENERAL AGGREGATE $ 100,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS
Bicycle Racing / Running / USA
Additional Insured(s): Effective 1/2412013, Certificate holder(s) arels 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 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 IMPOSE
NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Zr/~•®Ecd, Harold Laid