Procession - Michiana Runners Association

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�0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 8/14/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Ees) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER STAR Insurance - Fort Wayne Office 2130 East Dupont Road Fort Wayne IN 46825 CONTACT Margaret Mayers NAME: g y PHONED . Elth(260)467-5689 A� No; (260)467 5697 AD RIESS:margaret.mayers@star£inancial.com INSURERS AFFORDING COVERAGE NAIC # INSURERANational Casualty CompanyCoTpany 11991 INSURED Road Runners Club of America/2017 and Its Member Clubs 1501 Lee highway, Suite 140 ,Arlington VA 22209 INSURERB:Nationwride Life Insurance Co. 66869 INSURER C : INSURERD: INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER:2017 $1M A. I. REVISION NUMBER: THIS IS TO CERTIFY THAT 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR OF INSURANCE ADDLTYPE INSD WVD SUER POLICY NUMBER MMI€lDIYEYYY XP MM/©D1YYIYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE 1XI OCCUR PREM SES' a occuRENTED nce $ 500,000 MED EXP (Any one person) $ 5,000 X Legal Liability to wRo0000006655200 12/31/2016 12/31/2017 Participant $1,000,000 PERSONAL & ADV INJURY $ 1,000,000 12:01 AM 12:01 AM GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Unlimited X POLICY ❑ PRO- P ❑ LOG .Abuse & Molestation PRODUCTS - COMPlOPAGG $ 1,000,000 Abuse and Molestation $ 500,000 OTHER: Aggregate $5,000,000 AUTOMOBILE LIABILITY MBINED SINGLE LIMIT accide (CEO nt $ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS KR00000006655200 12/31/2016 12/31/2017 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS X AUTOS 12: 61 AM 12: Dl AM UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4 AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERJFArCUTIVE SPTEROTH- 7 ER E.L. EACH ACCIDENT $ OFFiCER1MEM8ER EXCLUDED? "NIA {Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION Of OPERATIONS below B Excess Medical & Accident SPX0000027889600 12/31/2016 12/31/2017 Excess Medical $10, 000 ($250 Deductible/Claim) 12:01 AM 12:01 AM AD & Specific Loss $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS TO THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE OF EVENT(S): 09/09/17 Game Day Chase 5k/10k INSURED FRRCA CLUB/EVENT MEMBER: Michiana Runners Association Inc., Att'n: Ryan Fenstermaker, 4124 Old Cleveland Road, South Bend, IN 46628 rI=PTIFIr..ATF Wnl nFR CANIrFl..LATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 09/09/17 City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 731 S . Lafayette Blvd. ACCORDANCE WITH THE POLICY PROVISIONS, South Bend, IN 46601 AUTHORIZED REPRESENTATIVE Terry Diller/MMA �� 'T { R __ h�-QSJ�z t Pc V ACORD 25 (2014101) 1NS025 (901401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD