HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Association (4)
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Certificate of General Liability & Accident Medical Insurance DAT0320/20 2 m
PRODUCER Phone: (800) 747-9573 Fax: (343) 422-1276 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3
The Camp Team ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i
9035 Wadsworth Pkwy., Suite 3840 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Vestminster, CO 80021 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED Sports and Recreaton 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 I
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 WITH RESPECT TO W RICH THIS CERTIFICATE MAYBE 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.
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LTR ~ t6F~ll TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MMIDDIYY) DATE (MWDD/YY)
GENERAL LIABILITY FLOG 180412-API 53681 0111612012 01/1612013 EACH OCCURRENCE 1,000,000
X COMMERCIAL GENERAL LIABILITY IRE DAMAGE (Anyone fire) 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 21000,000
RODUCTS•COMPIOP AGO. 2,000,000
UTOMOBILE LIABILITY FLDC180412-AP153681 01/16/2012 01/16/2013 COMBINED SINGLE LIMIT 1,000,000
ANY AUTO {Ea aoadent)
ALL OWNED AUTOS 0DILY INJURY
SCHEDULED AUTOS Per person)
A
X HIRED AUTOS
OOILY INJURY
X NON-OWNEDAUTOS Peefr accident)
rROPERTY DAMAGE
(Per accident)
ACCIDENT MEDICAL AXIMUM MEDICAL BENEFIT 10,000
71ER CLAW
X CCIDENTAL DEATH & 2,500
Excess To Primary Health Ins. DISMEMBERMENT
8 Policy will not cover primary health PAT L.00227 769-001 01116!2012 oili 612013
insurance deductibles, co-pays.
X program limits. or out of network care.
EDUCTIBLE PER CLAIM 1,000
If injured party does not have primary
care, excess coverage becomes
primary.
EXCESS I UMBRELLA LIABILITY XSDO100241 01/1612012 01/1612013 EACH OCCURRENCE 1,000,000
X OCCUR CLAIMS MADE AGGREGATE 1,000,000
CUOUCTIBLE
RETENTION $
OTHER: ABUSE AND MOLESTATION FLDC180412-AP153681 01/16/2012 01/1612013 EACH OCCURRENCE $ 100,000
A IGENERAL AGGREGATE $ 100,000
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS
Bicycle / Running Races / 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.
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CERTIFICATE HOLDER CANCELLATION
Thomas Rollins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
1631 Peachy Rd DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE I 0 SO SHALL Ashland, OR TNOO OBLIGATK)N ~ilaaILInof ANY KIND
THE LEFT, BUT FAILE PON THE INSURER TSOADGEENTS OR POSE
REPRESENTATIVES.
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AUTHORIZED REPRESENTATIVE i
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Bob Leid j