HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Association
DATE (MM/DD/YYYY)
Certificate of General Liability & Accident Medical Insurance 01/19/2009
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
Nheat 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: StarNet Insurance Company
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 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 ADD'l TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
QTR INSRD DATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL LIABILITY CS00217968 01/16/2009 01/16/2010 EACH OCCURRENCE 1,000,000
X DAMAGE TO RENTED 100,000
COMMERCIAL GENERAL LIABILITY REMISES (Ea occurrence)
CLAIMS M ,bE X OCCUR MED. EXP (Spectator Only) 5,000
A X INC ATHLETIC; PARTICIPANTS PERSONAL 8 ADV INJURY 11,000,000
GENERAL AGGREGATE 2,000,000
PRODUCTS COMP/OP AGG. 1 .000,000
BODILY INJURY 0
X DEDUCTIBLES PROPERTY DAMAGE 500
AUTOMOBILE LIABILITY CS00217968 01/16/2009 01/16/2010 COMBINED SINGLE LIMIT 1,000,000
ANY AUTO Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS Per person)
A
X HIRED AUTOS
BODILY INJURY
X NON-OWNED AUTOS Per accident
PROPERTY DAMAGE
Per accident)
ACCIDENT MEDICAL MAXIMUM MEDICAL BENEFIT 10,000
PER CLAIM
X ACCIDENTAL DEATH & 2,500
Excess To Primary Health Ins DISMEMBERMENT
B Policy will not cover primary health To Be Determined 01/16/2009 01/16/2010
insurance deductibles, co-pays,
X program limits, of out of network care.
It injured party does not have primary DEDUCTIBLE PER CLAIM 1 ,000
care, excess coverage becomes
primary.
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE
OCCUR CLAIMS MADE AGGREGATE
DEDUCTIBLE
RETENTION $
OTHER-
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS
Spring Traw Mountain Bike Festival XC and DH Mountain Bike Race / USA
Additional Insured(s): City of Ashland and its employees, United States Forest Service, Richard Palen, Ernst Holdings, LLC, Thomas Rollins, 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
SOMBA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Amy Warner DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE
TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE
PO Box 1194 NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S AGENTS OR
Talent, OR 97540 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
attention: -
Z., Bob Leid