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-_ __ ~;1=RrrFICATE O~ IN~VRANCE <br />PRODUCER - <br />American Specialty Insurance & Risk Services, Inc. <br />142 North Main Street <br />Roanoke, Indiana 46783 <br />INSURED <br />USA Track & Field, Inc. <br />132 East Washington Street, Suite 800 <br />Indianapo4is, IN 0.6204-3723 <br />CARE OF SOUTH BEND <br />P.O. BOX 1481 <br />SOUTH BEND., IN 46624 <br />~ 02/17/2eos <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICY BELOW. <br />INSURERS AFFORDfNG COVERAGE <br />INS. A: AXIS Insurance (:mm~anv <br />INS. B: <br />INS. C: <br />CERT NUMBER: 1000746556 <br />EVENT CODE• 09 16 001 <br />COVERAGES <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, NOT WITHSTANDING 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 CONDITION OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. <br />INS POLICY POLICY POLICY <br />LTR TYPE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS <br />General A re ate 2,000,00( <br />GL AXGL01100182-08 11/01/2008 11/01/2009 Products-Com leted erations A re ate 1,000.00( <br />A 12:01 a.m. 12:01 a.m. Personal and Advertisin In'u 1,000,00( <br />DESCRIPTION OF OPERATIONS/LOCATIONSlVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTlSPECIAL PROVISIONS <br />Coverage applies to USA Track & Field sanctioned events and registered practices, including any directly related activities, such as event set-up and tear-down, participant check-in and <br />award ceremonies. <br />The Certificateholder is only an additional insured with respect to liability caused by the negligence of the Named Insured as per Form AXIS 7003-Additional Insured - <br />j Ceitificateholders.but only with respect to the RUN-TEN-TEN on April 25. 2009 <br />CERTIFICATE HOLDER <br /> <br />CITY OF SOUTH BEND AND THE BOARD OF PARKS COMMISSIONER CANCELLATION <br />ATTN: BETSY HARRIMAN SHOULD ANY OF THE ABOVE DESCRIBED <br />102D HIGH STREET POLICIES BE CANCELED BEFORE THE <br />SOUTH BEND, IN 46601 EXPIRATION DATE THEREOF. THE ISSUING <br /> COMPANY WILL ENDEAVOR TO MAIL 30 DAYS <br /> WRITTEN NOTICE TO THE CERTIFICATE <br /> HOLDER, BUT FAILURE TO MAIL SUCH NOTICE <br /> SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> OF ANY KIND UPON THE COMPANY, ITS <br /> AGENTS OR REPRESENTATIVES. <br />Au I HOR¢ED REPRnnESENTATIVE <br />' ~~C+ <br />1 <br />