HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Association (2)
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'Certificate of General Liability & Accident Medical Insurance °AT032o2012 I
PRODUCER Phone: (800) 747-5573 Fax: (303) 422-1276 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The Camp Team ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
8035 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 Pro.iders assoc. (purchasing group) and its members. Y INSURER A: Riverport Insurance Company
Oregon Bicycle Racing Association INSURER B: BerWey Life & stealth Ins. co.
P.O. Box 5773 INSURER C:
Salem, OR 87304
fNSURER 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 CONTRACTOR OTHER DOCUMENT W ITH RESPECT TO W HIGH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCI= 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 CLAV~IS.
tNSR AWL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR t DATE (MMDD/YY) DATE (MM1DD/Y1f)
GENERAL LIABILITY FLDC180412-AP15368i 01M612012 01/16/2013 EACH OCCURRENCE 1,000,000
X COMMERCIAL GENERAL LIABILITY IRE DAMAGE (Any one fire) 300,000
CLAIMS MADE X OCCUR LED. EXP (Spectators Only) 5,000
A X INC ATHLETIC PARTICIPANTS ERSONAL & ADV INJURY 1,000,000
ENERAL AGGREGATE 2,000,000
PRODUCTS-COMPIOP AGG. 2,000,000
UTOMOBILE LIABILITY FLDC180412-AP153681 01116/2012 01/1612013 OMBINED SINGLE LIMIT $ 1,000,000
Ea accident)
ANY AUTO
ALL OWNED AUTOS ODILY INJURY
SCHEDULED AUTOS Per person)
A X HIRED AUTOS
X NON-OWNEDAUTOS P 'OaccINJURY
accident
Per
'ROPE RTY DAMAGE
,(Per accident)
ACCIDENT MEDICAL fAXWUM MEDICAL BENEFIT 10,000
ER CLADd
X CCtDENTAL DEATH & 2,500
Excess To Prima Health Ins. ISMEMBERMENT
B Policy will not corer primary health PAI L00227769-001 01/16/2012 01 /i 612013
insurance deductibles, co-pays,
program Gmils, or out of network care. EDUCTIBLE PER CLAIM 1,000
X N injured party does not have primary
care, excess ootierage becomes
primary.
XCESS t UMBRELLA LIABILITY XSDO100241 0111612012 01/16/2013 EACH OCCURRENCE 1,000,000
X OCCUR CLAIMS MADE GGGEGATE 1,000,000
A
'DEDUCTIBLE
RETENTION $
OTHER: ABUSE AND MOLESTATION FLDC180412-AP153681 01/16/2012 01/16/2013 EACH OCCURRENCE $ 100,000
A GENERAL AGGREGATE $ 100,000
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS
Bicycle I Running Races I Ashland Mountain Challenge t USA
Additional insured(s): Certificate Holder(s) is / are added as additional insured in regards to the operations of the insured.
CERTIFICATE HOLDER CANCELLATION
Rogue River- Skiskiyou National Forest SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
645 Washington St. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE
Ashland, OR TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE
NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATlVE
aev~~l I Bob Leid