HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Association (5)
DATE (M111DDIYYYY)
Certificate of General Liability & Accident Medical Insurance 03/20/2012
PRODUCER Phone: (800) 747-9573 Fax: (303) 422-1~Y6 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
Vestminster, 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 tSSUED 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.
IrdSR ADtri TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTH r, p DATE (MMIDDIYY) DATE (MM/DD/YY)
GENERAL LIABILITY FLOC1804i2-AP153681 01/16/2012 01/16/2013 EACH OCCURRENCE 1,000,000
X COMMERCIAL GENERAL LIABILITY IRE DAMAGE (Anyone fire) 300,000
CLAIMS MADE X OCCUR ED. EXP (Spectato(s Onty) 51000
A X INC ATHLETIC PARTICIPANTS ERSONAL 8 ADV INJURY 1,000,000
ENERAL AGGREGATE 2,000,000
RODUCTS-COMP/OP AGG. 2,000,000
I UTOMOBILE LIABILITY FLD0180412-API 53681 01/16/2012 01/16/2013 +COINBINEDSINGLE LAIIT 1,000,000
ANY AUTO (Ea accident)
ALL OWNED AUTOS 0DILY INJURY
SCHEDULED AUTOS Per person)
A X HIRED AUTOS $
PODILY INJURY
X NON-OWNED AUTOS Per accident
FROPERTY DAMAGE
{Per accident)
ACCIDENT MEDICAL AXIMUM MEDICAL BENEFIT 10,000
ER CLAIM
CCIDENTAL DEATH & $ 2,500
X Excess To Prima Health Ins. tSMEMBERMENT
B Policy will not cover primary health PAI L00227769.001 01116120 12 01/1612013
insurance deductibles, co-pays,
program limits, or out of network care. EDUCTIBLE PER CLAIM 1,000
X It injured party does not have primary
care, excess coverage becomes
primary.
XCESS / UMBRELLA LIABILITY XSD0100241 0111612012 01/16/2013 EACH OCCURRENCE 1,000,000
X OCCUR CLAIMS MADE AGGREGATE 1,000,000
A
DEDUCTIBLE
RETENTION $
QTHER: ABUSE AND MOLESTATION FLOC180412-AP153681 01/16/2012 01/1612013 EACH OCCURRENCE $ 100,000
A
GENERAL AGGREGATE $ 100,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS 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
Andy Ernst SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
21087 Cabot Blvd, Ste. 6 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO }BAIL 30 DAYS WRITTEN NOTICE
TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE
Hayward, CA NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
( Bob Lejd
I