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A� Qe CERTIFICATE OF LIABILITY INSURANCE <br />DATEWD <br />TEI /2oiYe ) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />STAR Insurance - Fort Wayne Office <br />2130 East Dupont Road <br />Fort Wayne IN 46825 <br />NAMEA Margaret M. Mayers <br />NONE (260)467-5689 FpIXC No:(26D)467-5691 <br />p.margaret.mayers0starfinancial.com <br />INSURE 6 AFFORDING COVERAGE <br />NAICS <br />INwRERA National Casualty Coompany <br />11991 <br />INSURED <br />Road Runners Club of America/2016 and Its <br />Nember Clubs <br />1501 Lee Highway, Suite 140 <br />Arlington VA 22209 <br />INSURERS Nationwide Life Insurance Co. <br />66869 <br />INSURERC: <br />INSURER D: <br />WSURERE: <br />NSURERF: <br />COVERAGES CERTIFICATE NUMBER:2016 $21A A.I. REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />SR <br />TYPEGFNSURANCE <br />SUER <br />Pol1CYNUMBER <br />POLL EPY <br />POLICYEXP <br />LIMITS <br />A <br />R <br />COMMERCIAL GENERAL LIABILITY <br />ClNMB-MADE OX OCCUR <br />EACH OCCURRENCE <br />5 2,000,000 <br />ENTED <br />mrm&i IFNa ..I <br />S 500,000 <br />R <br />MED FXP(My em Waon) <br />$ 5,000 <br />Lacal Liability to <br />MOOOD0005888100 <br />12/31/2015 <br />12/31/2016 <br />Participant $2,000,000 <br />PERSONAL& ADV INJURY <br />$ 2,000,000 <br />12:01 AM <br />12:01 AM <br />AGGREGATE UNAPPLIES PER: <br />GENERAL AGGREGATE <br />5 Unlimited <br />GEHL <br />R <br />POLICY JpECT LOC <br />Abuse S Molestation <br />PRODUCTS-COMPX)PAGG <br />S 2,000,000 <br />Abmoa tlMokclmlon <br />S 500,000 <br />OTHER. <br />Aggregate 05,000,000 <br />AUTOMOBRE <br />LIABILITY <br />EelNEO U <br />S 2,000,000 <br />BOULYINAMY(Pe,pamcn) <br />S <br />A <br />ANY AUTO <br />AUTOS 0 AUTOS SCHEDULED <br />AUTOS AWES <br />EE00000005888100 <br />12/31/2015 <br />12/31/2016 <br />BODILY INJURY ('mA a10 <br />S <br />R <br />HIRED AUTOS R ALTOS <br />12: 01 AM <br />12:01 AM <br />E <br />waa- PROPERTY DAMAGE <br />S <br />S <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CIANSWADE <br />DUD <br />i I <br />RETENTIONS <br />$ <br />WORSERS CONPENSATION <br />AND EMPLOYERS' LwBu1rY YIN <br />ANY PROPRIEV; PARTNERRECUDW <br />OFFICEWMEMBER EXCLUDED? �N/A <br />STA T ER <br />E.L. EACH ACCIDENT <br />S <br />E.L. DISEASE - EA EMPLOYE1 <br />S <br />aMsdalmy In NHl <br />WS yyees desuibs wds <br />DESCRIPTION OF OPERATIONS belay <br />E.L. DISEASE -POLICY UNIT <br />S <br />B <br />Excess Medical i Accident <br />t <br />aMW0000272D1500 <br />12/31/2015 <br />12/31/2016 <br />ram. Madlrel 010,000 <br />(0250 Deductible/Claim)I <br />12:01 AM <br />12:01 AM <br />AD&SpedfmLoss 62,500 <br />DESCRIPTION OP OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, AddRipoal Roo mse Scboduft, may be aleched It mom $paw Is w9umad) <br />CERTIFICATE BOLDER IS NAMED AS AN ADDITIONAL INSURE➢ AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE <br />NAMED INSURED. DATE OF EVENT(S): 09/27/16 Game Day Chase 5k/10k INSURED RRCA CLUB/EVENT <br />MEMBER: Michdana Runners Association Inc., Att'n: Ryan Fensteemaker, 4124 Old Cleveland Road, South <br />Bend, IN 46628 <br />09/17/16 City of South Bend <br />731 S. Lafayette Blvd. <br />South Bend, IN 46601 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />w <br />Diller/MMA-'�7�"'-}T R-:��i7✓L,G�PCU <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />INS025t201nn11 <br />