HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Association (3)
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Certificate of General Liability & Accident Medical Insurance DAT03/202012 '
PRODUCER Phone: (604) 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 rnembers. 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 DESCRI8ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR "I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR i DATE (MWDDIYY) DATE (MM1DDlYY)
GENERAL LIABILITY FLOC180412-AP153681 01116/2012 01/16/2013 EACH OCGURRETIGE 1,000,000
PX COMMERCIAL GENERAL LIABILITY IRE DAMAGE (Anyone fret 300,000
CLANS MADE x( OCCUR IED. EXP (Spectators Only) 5,000
A INC ATHLETIC PARTICIPANTS 71ERSONAL 9 ADV INJURY 1,000,000
ENERAL AGGREGATE 2,000,000
PRODUCTS-COMPIOP AGG. 2,000,000
UTOMOBIL£ LIABILITY FLD0180412 AP153681 01116/2012 01/1612013 COMBINED SINGLE LIMIT 1,000,000
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS Per person)
A
X HIREUAUTOS I
BODILY INJURY
X NON-OWNED AUTOS Per accident
PROPERTY DAMAGE
Per accident)
ACCIDENT MEDICAL tER MUMMEDICAL BENEFIT 10,000
CLAIM
X I CCIDENTAL DEATH & 21500
Excess To Prima Health Ins. 1SMEMBERMENT
S Policy will not cover primary health PAIL40227769-001 Oi11612012 Oi11612013
insurance deductibles, co-pays,
X program rimis, or out of network care. DEDUCTIBLE PER CLAIM 1,000
"injured party does not have primary care, excess coverage becomes
primary.
XCESS / UMBRELLA LIABILITY XSDO100241 01/16/2012 01/1612013 ACH OCCURRENCE 1,000,000
X OCCUR CLAIMS MADE 'AGGREGATE 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
F
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCL.USIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS
Bicycle / Running Races / Ashland Mountain Challenge / USA
Additional Insured(s): Certificate Holder(s) is 1 are added as additional insured in regards to the operations of the insured.
CERTIFICATE HOLDER CANCELLATION
Kenneth Palen SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
2665 Alvarado Terr DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE
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TO THE CERTIFICATE HOLDER Salem, OR NO OBLIGATION OR LIABILITY OF ANY KIND PON THE INSURER, WS GENTS OR LL IMPOSE
REPRESENTATIVES-
AUTHORIZED REPRESENTATIV E '
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I Bob Leid
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