HomeMy WebLinkAboutInsurance Certificate: Oregon Bicycle Racing Association (6)
Certificate of General Liability & Accident Medical Insurance DAT0320/2012YY)
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. (pwchasing goup) and its members. INSURER A: Riverport Insurance Company
Oregon Bicycle Racing Association INSURER B: Berkley Life & Health Ins. Co.
P.O. Box 5773
ENSURER C:
Salem, OR 97344
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 W ITH 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 ADM TYPE OF INSURANCE POLICY HUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR NsRD DATE (MMIDDIYY) DATE (MWDDIYY)
GENERAL LIABILITY FLOC 180412-API 53681 0111612012 0111612013 EACH OCCURRENCE 1,400,000
X COMMERCIAL GENERAL LIABILITY IRE DAMAGE (Anyone fire) 300,000
1 CLAIMS MADE X OCCUR AED. EXP (Spectators Only) 5,000
A X INC ATHLETIC PARTICIPANTS ERSONAL 8 ADV INJURY 1,000,000
GENERAL AGGREGATE 2,000,000
PRODUCTS-COMPIOP AGG. 2,000,000
UTOMOBILE LIABILITY FLDC180412 AP15368i 01/162012 01/16/2013 ICOhIBINEDSINGLE LKIIT $ (,000,000
1ANY AUTO {Ea accident)
ALL OWNED AUTOS 0D1LY INJURY
A SCHEDULED AUTOS Per person)
X HIRED AUTOS
OMLY INJURY
X NON-OWNEDAUTOS Per accident
ROPERTY DAMAGE
{Per accident)
ACCIDENT MEDICAL AAXtMUM MEDICAL BENEFIT 10,000
ER CLAIM
X ISMER BERMENT 2,600
Excess To Primary Health ins.
B Policy will notcover primary health PAILW227769-001 OiMW2012 01116;2013
insurance deductibles, co-pays,
X program knits, or out of network care.
H injured party does riot have primary EDUCTIBLE PER CLAIM $ 1,000
care, excess coverage becomes
primary.
EXCESS / UMBRELLA LIABILITY XSDO100241 01116/2012 01/16/2013 ACH OCCURRENCE 1,000,000
X OCCUR CLAIMS MADE AGGREGATE 1,000,000
A DEDUCTOLE
RETENTION $ 1 i$
OTHER: ABUSE AND MOLESTATION FLDC180412-AP153681 01/16/2012 01/1612013 ACH OCCURRENCE $ 100,000
A (GENERAL AGGREGATE $ 100,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTS/SPECIAL PROVISIONS
Bicycle / Running Races I 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 - -
City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
51 Winburn Way DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAN. 30 DAYS WRITTEN NOTICE
TO THE CERTIFICATE HOLDER Ashland, OR OOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR LL IMPOSE
REPRESENTATIVES.
AUTHRIZED REPRESENTATNE i+
I
i Bob Leid