HomeMy WebLinkAboutInsurance Certificate: Siskiyou Velo
AXIS 8000(08/10) CERTIFICATE OF INSURANCE 03/16/2012
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY
American Specialty Insurance & Risk Services, Inc. OR NEGATIVELY AMEND, EXTEND. OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
142 North Main Street BELOW rHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT
BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND
Roanoke, Indiana 46783 THE CERTIFICATE HOLDER.
INSURED INSURERS AFFORDING COVERAGE
League of American Wheelmen dba League of American Bicyclists INS. A: AXIS Insurance Company
1612 K Street NW, Suite 510 INS. B:
Washington, DC 20006 INS. C:
SISKIYOU VELO
P.O. BOX 974
ASHLAND, OR 97520
CERT NUMBER: 1001023807
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOT WITHSTANDING 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.
INS POLICY POLICY POLICY
LTR TYPE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS
General Aggregate - Per Club 3,000,000
GL AXGL03102049-12 02/01/2012 02/01/2013 Prod ucts-Com leted Operations Aggregate 3,000,000
A Personal and Advertising Iniu 1,000,000
12:01 a.m. 12:01 a.m. Each Occurrence 1,000,000
Damage to Premises Rented to You An One PremiSes) 1 000 000
Medical Expense Limit An One Person Excluded
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The Certificateholder is only an additional insured with respect to liability caused by the negligence of the Named Insured as per Form AXIS 1003-Additional Insured-Certificateholders,
but only with respect to MOUNTAIN LAKES CHALLENGE on June 23, 2012.
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES
20 EAST MAIN STREET BE CANCELLED BEFORE THE EXPIRATION DATE
ASHLAND, OR 97520 THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
M AY - 9 2012
AUTHORIZED REPRESENTATIVE