HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Association
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DATE (MWDD/YYYY)
Certificate of General Liability & Accident Medical Insurance 03/2012012
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
9035 Wadsworth Pkwy., Suite 3840 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Westminster, CO 80021 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED Sports and Recreation Providers Assoc. (purchasing group) and its members. INSURER A: Riverport Insurance Company
Oregon Bicycle Racing Association INSURER B: Berkley Life & Health Ins. Co.
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 PDDL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR FSM DATE (MMJDDfYY) DATE (MMIDDIYY)
GENERAL LIABILITY FLDCi80412-AP153681 006/2012 01/1612013 EACH OCCURRENCE 1,000,000
X COMMERCIAL GENERAL LIABILITY IRE DAMAGE (Anyone fi(e) 300,000
-1 CLAIMS MADE X OCCUR ED. EXP (Spectators Only) 5,000
A X INC ATHLETIC PARTICIPANTS ERSONAL & ADV INJURY 1,000,000
ENERAL AGGREGATE 2,000,000
PRODUCTS-COMP/OP AGG. 2,000,000
AUTOMOBILE LIABILITY FLDG180412-Af 153681 01/16/2012 01/16/2013 COMBINED SINGLE LWIT 1,000,000
ANY AUTO (Ea accident)
ALL OW NED AUTOS BODILY INJURY
A SCHEDULED AUTOS Per person)
X HIRED AUTOS
X NON•OWNEDAUTOS Peer accident)
~ rROPE RTY DAMAGE
Per accident)
ACCIDENT MEDICAL AXIMUM MEDICAL BENEFIT 10,000
PER CLAIM
X CCIDENTAL DEATH & 2,500
Excess To Primary Health Ins. ISMEMBERMENT
B Policy wig not cover primary health PAI L00227769-001 0111612012 01!1612013
Insurance deductibles, co•pays,
program limits, or out of network care. EDUCTIBLE PER CLAIM 1,000
X If injured party does not have primary
care, excess coverage becomes
primary.
XCESS I UMBRELLA LIABILITY XSD0100241 01/16/2012 01/1612013 CH OCCURRENCE 1,000,000
X OCCUR CLAIMS MADE AGGREGATE 1,000,000
A
DEDUCTIBLE
RETENTION $
OTHER: ABUSE AND MOLESTATION FLDC180412 AP15368i 01/1612012 01/16/2013 EACH OCCURRENCE $ 100,000
A GENERAL AGGREGATE $ 100,000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS
Bicycle / Running Races / Ashland Mountain Challenge / USA
Additional Insured(s): Certificate Holder(s) is / are added as additional insured In regards to the operations of the insured.
CERTIFICATE HOLDER_ _ CANCELLATION
Ashland Mountain Challenge SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
700 Mistletoe Rd, Suite 105 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
Ashland, OR 97520 NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
{ Bob Leid
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