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HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Assoc ACORDTM CERTIFICATE OF LIABILITY INSURANCE DAT0605/2007 YY) 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 7615 W. 38Th Avenue, Unit B-109 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Wheat Ridge CO 80033 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Capitol Speciality Ins. Corp Oregon Bicycle Racing Association INSURER B: P.O. Box 16355 INSURER C: Portland, OR 97292 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 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. NSR ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR n6RO DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY CS00217968-19561 06/10/2007 06/10/2007 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 1 00 000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) CLAIMS MADE X OCCUR MED. EXP (Any one person) 5,000 A X INC ATHLETIC PARTICIPANTS PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS-COMP/OP AGG. 1,000,000 POLIC PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/ UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- EMPLOYERS LIABILITY TORY LIMITS THER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $ It yes, describe under PECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $ OTHER: $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS Super Drace Cross County, Downhill Race / USA Policy Deductibles: $0.00 per each bodily injury / $500.00 per each property damage claim. Additional tnsured(s): US Government c/o Ashland Ranger District The City of Ashland, it's Agents and Employees, BreakAway Events, Ernst Holdings LLC., Thomas Rollins, Ken and Margaret Palen, MT. Ashland Ski Resort. All participants, staff and facilities as scheduled with the company are added as additional insured in regards to the operations of the insured. CERTIFICATE HOLDER CANCELLATION 12 Mlle Superd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Tita Soriano DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 280 N. 2nd St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Attention: Bob Leid ACORD 25 (2001/08) © ACORD CORPORATION 1988 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DAT08/13/2007YY) 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 7615 W. 38Th Avenue, Unit B-109 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Wheat Ridge CO 80033 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. i INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Capitol Speciality Ins. Corp Oregon Bicycle Racing Association INSURER B: P.O. Box 16355 INSURER C: Portland, OR 97292 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 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. INSR ADUL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR rSRD DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY CS218051 09/30/2007 09/30/2007 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) X CLAIMS MADE X OCCUR MED. EXP (Any one person) 5,000 A [jX INC ATHLETIC PARTICIPANTS PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS-COMP/OP AGG. 1,000,000 i POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) I HIRED AUTOS i$ BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ ;AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ I I I DEDUCTIBLE $ RETENTION $ I $ - ORKERS COMPENSATION AND WC T RY LIMI STATU- TORY THER ,EMPLOYERS LIABILITY NY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ ,If EXCLUDED? E.L. DISEASE-EA EMPLOYEE $ ,If yes, describe under jSPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $ ,OTHER: $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS Hill Climb Road + MTB / USA Policy Deductibles: $0.00 per each bodily injury / $500.00 per each property damage claim. Additional Insured(s): See Attached. CERTIFICATE HOLDER CANCELLATION United States Government, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE c/o USDA Forest Service, Mt. Ashland Hill Climb TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE 1177 Glen rove NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S AGENTS OR g REPRESENTATIVES. Central Point, OR 97502 AUTHORIZED REPRESENTATIVE Attention: Steve Johnson Bob Leid ACORD 25 (2001/08) © ACORD CORPORATION 1988