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HomeMy WebLinkAboutInsurance Certificate: Kiwanis International i ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 9/2/2014 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(ies) 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 NA Co T CT ME: Adam Reiff Hylant Group Inc-Indianapolis P INC, HONE o Exti:317-817-5139 FAX No : 17- 17- 1 1 301 Pennsylvania Parkway, #201 Al IIESS: m.r iff h I n . m Indianapolis IN 46280 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Lexington Insurance Company 19437 INSURED KIWAN03 INSURER B : Kiwanis International, All Clubs and Their Members INSURERC: 3636 Woodview Trace INSURER D : Indianapolis IN 46268 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 1144873471 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. I~iR R TYPE OF INSURANCE IN R WI D POLICY NUMBER MWPOLICY DD EFF MP WDDY YEXP Y LIMITS A GENERAL LIABILITY Y 13136005 11/1/2013 1/1/2014 EACH OCCURRENCE $2,000,000 DAMAGE To RENTED X COMMERCIAL GENERAL LIABILITY PR EMISES (E. occurrence) CLAIMS-MADE K OCCUR MED EXP (Any one person) $5,000 X Agg Per District PERSONAL & ADV INJURY $2,000,000 X Liquor Liability GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY J`ERG0j 1-1 LOC Liquor Liability $1,000,000 A AUTOMOBILE LIABILITY 11/1/2013 1/1/2014 013136005 Ea acc dent $1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS PROPER TY DAMAGE I) X HIRED AUTOS X AOOW"ED Pera.den $ [Aggregate $3,000,000 UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY y / N TORY LIMIT R ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Self-Insured Retention 13136005 1/1/2013 1/1/2014 All Claims $75,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is named as Additional Insured as respects to General Liability only regarding the following Kiwanis event (setup, take down & rain date(s) are included): 10/25/2014 or any future date(s) during the policy term - 1 Mile, 5K and 10K Run in Lithia Park, Ashland, OR i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland, its agents and employees ACCORDANCE WITH THE POLICY PROVISIONS. Attn: David Kanner 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD