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HomeMy WebLinkAboutInsurance Certificate: Road Runners Club of America AC~ ® DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 9/4/2009 PRODUCER (260) 4 6 7 - 5 6 9 0 FAX : (260) 4 6 7 -5651 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION STAR Insurance - Fort Wayne Office ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 130 East DuPont Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Wayne IN 46825 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A NATIONAL CASUALTY COMPANY 11991 ROAD RUNNERS CLUB OF AMERICA/2009 INSURER E NATIONWIDE LIFE 66869 AND ITS MEMBER CLUBS INSURER C. 6434 POUND APPLE COURT INSURER D COLUMBIA MD 21045 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 OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION' LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1, 000 - , 000 - - - -DAMAGETO RENTED X COMMERCIAL GENERAL LIABILITY I PROS CEa occurrence)-- - _ $ 300, 000 A CLAIMS MADE X OCCUR KROOOOOOO0172601 12/31/2008 12/31/2009 1 MED EXP (Any one person) $ 5, 000 X LEGAL L IAB . TO PART. 12:01 A.M. 12:01 A.M. PERSONAL & ADV INJURY $ 1,000, 000 $1,000,000 GENERAL AGGREGATE $ NONE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 - PRO- - POLICY E T LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 A ALL OWNED AUTOS KROOOOOOO0172601 12/31/2008 12/31/2009 BODILY INJURY $ ' 'SCHEDULED AUTOS 12:01 A.M. 12:01 A.M. (Per person) X HIRED AUTOS BODILY INJURY $ (Per accident) X 'NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ _ 'OTHER THAN AUTO ONLY AGG $ EXCESS/ UMBRELLA LIABILITY ! EACH OCCURRENCE $ OCCUR EJ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY _TORY LIMITS __-ER_;_- Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1-- - - - (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below ; E.L. DISEASE - POLICY LIMIT $ B OTHEREXCESS ACCIDENT & SPX0000003566300 12/31/2008 12/31/2009 EXCESS MEDICAL $10,000 MEDICAL 12:01 A.M. 12:01 A.M. ! $250 DEDUCTIBLE PER CLAIM $2,500 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CITY OF ASHLAND, OREGON, ITS OFFICERS, AGENTS AND EMPLOYEES ARE NAMED ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE & EVENT: 10/24/09 BIRDS OF A FEATHER RUN INSURED CLUB: SOUTHERN OREGON RUNNERS, ATTN: MIKE BARRETT; P.O. BOX 665; MEDFORD, OR 97501 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 10/24/09 CITY OF ASHLAND, OREGON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR MAIL 3 0 DAYS WRITTEN ATTN : MARTHA BENNETT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 20 EAST MAIN STREET ASHLAND, OR 97520 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE John Lefever/JR ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD