Special Event - Sunburst Races - June 1

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A` )II CERTIFICATE OF LIABILITY INSURANCE GATE IMM DD YYYY) 03/25/2024 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(ies) must have ADDITIONAL INSURED provisions or 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 endomement(s). PRODUCER CONTACT NONE: Taotha Messersmith Insurance Management Group PHONN ex (800) 272-8673 uc W: (765) 664-0761 ADDBesB: Ieswmmith@insmgt.wm 959 East 4th St INSURERS AFFORDING COVERAGE NAICI INSURERA: Granite State Insurance Company 23809 Nlarion IN 46952 INSURED INSURER B: National Union Fire Insurance Company of Pittsburgh. PA 19445 Road Runners Club of America/2024 and Its Member Clubs INSURER C: INSURER 0 INSURER E 1501 Langston Boulevard, Suite 140 Arlington VA 22209 INSURER F: COVERAGES CERTIFICATE NUMBER: 2024$2MA.1. Liability 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSO POLICY NUMBER POI MMM MMMD LIMITS X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE S 2,000.000 CLAIMS -MADE ®OCCUR PREMISES Eii xcunence $ 500,000 MED EXP (My one on $ 5,000 Legal Liability to Participants $2,000.000 PERSONALAADVINJURY 6 2,000,000 A AIL0003450335200 12/31/2023 12/31/2024 GENT AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE S 5,000.000 POLICY ❑ JECT LOC PRODUCTS AGO IS 2,000,000 Abuse and Molestation s 500,000 x OTHER I Per Event Basis AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 2,000.000 BODILY INJURY (Per Person) $ ANVAUTO A OWNED SCHEDULED AUTOS ONLY AUTO$ AIL0003450335200 12/3112023 12/31/2024 BODILY INJURY (Per III$ HIRED NON -OWNED AUTOS ONLY AUTO$ ONLY PROPERTY DAMA E Per amldent S E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAS CIAIMS-MADE DIED I I RETENTION S S WORKERS COMPENSATION ANDEMPLOYERSLIABILITY YIN I PER TH- STATUTE ER E.L. EACH ACCIDENT 5 ANY PROPRIETOWPARTNER/EXECUTIVE OFFICEMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandmonr In NH) d yes, d Pbe under DESCRIPTION OF OPERATIONS W. E.L. DISEASE -POLICY LIMIT $ Excess Medical $10,000 Excess Medical & Accident B ($250 Deductible/Claim) AID0003450335800 12/31/2023 12/31/2024 AD & Specific Loss $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Sch".1a. mry be MMcbed if mA..pan Ia raRaindl CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS TO THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE OF EVENT(S): DW01/24 Sunburst Races, Road Race INSURED RRCA CLUB/EVENT MEMBER: Beacon Health System DBA Sunburst Races ATTN: Courtney Kipker, 111 W. Jefferson Blvd. Suite 300, South Bend IN 46601 Processed by RMV CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 06101/24 The City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Blvd. AUTHORIZED REPRESENTATIVE South Bend IN 46601 of A . NA1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD