HomeMy WebLinkAboutProcession - Hoosier HikersINTER -OFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
DATE SENT: 8/28/2017
TO: *d Gleckler, Traffic & Lighting
Federico Rodriguez, Fire Department
Matt Longfellow, Engineering
�(Kara Wood, Park Department
Lt. Gene Eyster, Police Department
ill Sciccitano, Downtown South Bend
/Marcia Qualls, Streets
Legal Department
FROM: Linda M. Martin, Clerk . CO
SUBJECT: PROCESSION RECOMMENDATION-Volksmarch
SPONSOR: Hoosier Hikers
DATE OF EVENT: October 22, 2017 10:30am-6:00pm
DATE DUE: September 5,_ 2017
FAX OR E-MAIL TO: 235-9171 1 Imartin(a)-southbendin.gov
RECOMMENDATIONS AND COMMENTS:
By Date
APPLICATION FOR USE OF
PUBLIC RIGHT-OF-WAY FOR PROCESSIONS
The Board of Public Works must have FOUR (4) weeks prior notice of the
Sponsor: HOOSIER HIKERS Submitted By: ROBERT A BUZOLICH
Address: PO BOX 11101
City: SOUTH BEND
State: IN Zip: 46634 Phone: 574.339-9140
Sponsor may use the public right-of-way described as (describe route and attach map)
SEE ATTACHED MAPS AND ROUTE DESCRIPTIONS
PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO
CHANGE YOUR ROUTE FOR SAFETY PURPOSES
Event name: _VOLKSMARCH
X The Board of Public Works must have FOUR (4) weeks prior notice before event occurs
X All certificates of insurance, pre -paid costs, maps, and any other applicable information requested
or required by the Board of Public Works have been provided with this application
X The event shall be held on OCTOBER 22, 2017 and no other date
®X Registration time for the event starts at 10:30 a.m.
x❑ Starting time of the procession is I1.00 a.m.,
® Estimated completion time is 6:00 p,m.
This event involves the use of the following roadways
X This event involves City streets
❑ This event involves County roads
❑ This event involves State highways
X This event involves use of a park (Must obtain permission from Park Board)
❑ I understand that I must arrange a meeting with all affected governmental agencies to
organize the above event (Call Marcia Qualls, Customer Service Manager, 235-5939
to organize meeting)
X This event involves the use of the sidewalk
X Participants must stay on the sidewalk and obey all traffic laws.
X This event is a local/regional/national event (Please circle the appropriate event type)
X This event will be coordinated with the property owner/business where staging will take place
Updated 4/06/1.6 1
PERMITIAGREEMENT
FOR A PROCESSION
1. Sponsor shall reimburse the Board for the actual cost to the City for the event, if deemed
necessary.
2. Sponsor shall provide to the Board a Certificate of Insurance showing a liability policy in
full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00
aggregate and the City of South Bend listed as an additional named insured for this event.
3. Sponsor shall provide to the Board all additional licenses, permits and documentation
required for the event.
4. Sponsor agrees to abide by all terms and conditions of the Board's policy governing
walks, runs, parades or other similar event adopted by the Board on March 3, 1985.
5. In order to ensure public safety during the event, the Board agrees to furnish traffic
planning, materials, equipment and personnel as deemed necessary by the Police
Department Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable,
the Board of Park Commissioners.
6. Sponsor acknowledges that the Police Department reserves the right to change this route
for safety purposes.
7_ In consideration for approval by the Board and the use of the sidewalks for the purposes
set out above, the undersigned agrees and undertakes to hold the Civil City of South
Bend, Indiana, free and harmless from any liability loss, costs, costs, damages or
expenses, including attorney fees, which the Civil City of South Bend may suffer or
incur, as a result of any claims or actions which may be made by any person, including a
participant in said activity, arising out of the approval of the request to use the sidewalks
indicated in the City of South Bend. The undersigned certifies that he/she is authorized to
bind the above mentioned sponsor to the terms hereof.
$. Notification of approvaUdenial of this request ivill be issued by return of this form, upon
signed authorization by the Board of Public Works
I understand the above rules and regulations and that this application may be denied based on
any false or incomplete information.
Sponsor Signature���'�`�
Printed Name ROBERT A BUZOLICH
Title PRESIDENT
0�9OARD OF P LIC WO KS APPROVAL -P� 411JILIlt--
President Member Member
Member Menf er Date
RETURN FORM TO: 2
Board of Public Works
1316 County -City Building
227 West Jefferson Boulevard
SouLb Bend, IN 46601
Phone: (574) 235-9251 • Fax: (574) 235-9171 • E-Mail: publicwks@southbeadin.gov
2017 SOUTH BEND, INDIANA
12 KILOMETER VOLKSMARCH ROUTE
CAUTION: At all intersecting streets along the route please
cross cautiously using the pedestrian signal where available.
1) From the Start/Finish Point proceed North on the East Bank Trail.
2) Follow the East Bank trail North to its intersection with Angela Boulevard. You will
need to cross over the East Race between Colfax and LaSalle to continue North on the
East Bank Trail.
3) At the intersection of the East Bank Trail and Angela Boulevard you will encounter
Checkpoint #1, which is the first checkpoint for this route.
4) Upon clearing the checkpoint Turn Left onto Angela, and proceed in a Westerly
direction along Angela.
S) At the intersection of Angela and Riverside Drive you will encounter a traffic circle.
Turn Left onto Riverside Drive, and proceed along Riverside Drive using the available
sidewalks.
6) At the intersection of Riverside and California Avenue Turn Right onto Californian, and
proceed in a Westerly direction along California.
7) At the intersection of California Avenue and Portage Avenue proceed across Portage
using the pedestrian signal, and Turn Left onto Portage.
S) Proceed in a Southerly direction along Portage, which will become North William
Street. Continue along North William to its intersection with Colfax Avenue.
9) At the intersection of North William and Colfax Avenue Turn Right onto Colfax, and
proceed in a Westerly direction along Colfax. At the intersection of Colfax and Taylor
Street you pass the former residence of Schuyler Colfax, the 17th Vice President of the
United State.
10) At the intersection of Colfax and Elm Street Turn night, and proceed to the main
entrance of The South Bend City Cemetery. As you enter the cemetery you will see a
small obelisk with the name Colfax. In the same row and over three grave sites you
will find the grave site of Schuyler Colfax. This grave serves as CHECKPOINT 2, which is
unstaffed and without amenities. What is the year of death for Schuyler Colfax? On
your start card enter the year of death for Schuyler Colfax.
11) From the cemetery entrance Turn Left and make one loop through the cemetery using
the paved road.
12) Upon return to the cemetery entrance proceed in a Southerly direction on Elm Street.
13) At the intersection of Elm Street and Washington Street Turn Left onto Washington
and proceed in an Easterly direction along Washington. At the intersection of
Washington and Main Street you will see the St Joseph County Court House on your
right, where you will a replica of Lady Liberty.
14) Continue along Washington to its intersection with Martin Luther King Boulevard
(formerly St Joseph Street). Cross Martin Luther King Boulevard using the pedestrian
light, and Turn Left. Proceed in a Northerly direction along St Joseph.
15) At the intersection of Martin Luther King Boulevard (formerly St Joseph Street) and
LaSalle and Turn Right, and proceed along LaSalle.
16) Just prior to reaching the St Joseph River, you will see a trail to your right. This is the
West Bank Trail. Follow this trail through Gwen Stiver Park, Pier Park and the Island
Park at Century Center.
17) Continue along the West Bank Trail through Plaza Park until you reach the railroad
trestle. Turn Left onto the railroad trestle, and proceed over the St Joseph River.
18) Upon reaching the East Bank of the St Joseph River return to the Start/Finish Point, via
the East Bank Trail to Seitz Park.
2017 SOUTH BEND, INDIANA
6 KILOMETER VOLKSMARCH ROUTE
CAUTION: At all intersecting streets along the route please
cross cautiously using the pedestrian signal where available.
1) From the Start/Finish Point proceed due East to St Louis Boulevard, and Turn Right to
follow the sidewalk along St Louis Boulevard to the railroad trestle. Do not proceed
onto the trestle. Follow the sidewalk to the right of the trestle until you reach the
sidewalk on the banks of the St Joseph River, where you will pick up the East Bank
Trail.
2) Turn Right onto the East Bank Trail, and follow it North to Angela Boulevard. Along
the way you will need to crossover the East Race to Seitz Park between Jefferson and
Colfax to continue North on the East Bank Trail. You will also need to cross over the
East Race again between Colfax and LaSalle to continue North on the East Bank Trail.
3) At the intersection of the East Bank Trail and Angela Boulevard you will encounter
Checkpoint #1, which is the only checkpoint for this route.
4) Upon clearing the checkpoint Turn Right onto Angela, and proceed in an Easterly
direction along Angela.
5) At the intersection of Angela and Michigan Street cross Michigan Street using the
pedestrian light, and Turn Right. Proceed in a Southerly direction along Michigan
Street.
6) Upon reaching the South/West bank of the St Joseph River Turn Left and proceed
along the river bank through Leeper Park. At the intersection of Bartlett Street and
Riverside Drive cross over to sidewalk and continue along Riverside Drive.
7) At the intersection of Riverside Drive and Marion Street Turn Right onto Marion, and
proceed in a Westerly direction along Marion.
8) At the intersection of Marion and Michigan Street Turn Left, and proceed in a
Southerly direction along Michigan Street.
9) At the intersection of Michigan Street and LaSalle Avenue cross LaSalle using the
pedestrian signal, and Turn Left.
10) Just prior to reaching the St Joseph River, you will see a trail to your right. This is the
West Bank Trail. Follow this trail through Gwen Stiver Park, Pier Park and the island
Park at Century Center.
11) Continue along the West Bank Trail through Plaza Park until you reach the railroad
trestle. Turn Left onto the railroad trestle, and proceed over the St Joseph River.
12) Upon reaching the East Bank of the St Joseph River return to the Start/Finish Point.
2016 6 km Route in South Bend
Distance: 6.18 km
Elevation: 23.77 m (Max: 222.57 m)
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HOOSIER HIKERS
Post Office Box 11101
South Bend, Indiana 46634
August 26, 2017
South Bend Board of Public Works
227 West Jefferson
1316 County -City Building
South Bend, Indiana 46601
Dear Members of the South Bend Board of Public Works;
The Hoosier Hikers of South Bend, Indiana, request approval to conduct a Volksmarch (walk) on Sunday,
October 22, 2017, on properties administered by the South Bend Board of Parks & Recreation and the
South Bend Board of Public Works.
Our Volksmarch involve 6 and 12 kilometer non-competitive walks that will be sanctioned by the
International Volkssport Verband. The course will be in operation from 10:30 a.m. to 6 p.m. During this
period of operation, it is anticipated that there may be 30 to 60 participants from within and outside the
Michiana Area.
A description of the event operation is provided in the supplementary statement at TAB A. The
proposed routes for this event are provided at TAB B. Any special requests are identified at TAB C. The
organization requesting approval is described in the supplementary statement at TAB D.
The City of South Bend, the South Bend Board of Parks & Recreation and South Bend Venues Parks and
Arts will be named as additional insured's on the certificate of insurance provided at TAB E.
In conjunction with the proposed event a flyer will be distributed_ A copy of the current rendition of this
flyer is provided at TAB F.
For further information, please contact the undersigned at (574) 339-9140, or via email at
sonofbuzz@prodigy.net.
Sincerely,
Robert A. Buzolich
President, Hoosier Hikers
BRIEF HISTORY OF THE HOOSIER HIKERS
AND VOLKSSRORTING
The Hoosier Hikers was organized as a non-profit organization in 1991. It goal is to foster
health, fitness and fellowship through participation in Volkssporting activities.
The Club is a member organization in the Indiana Volkssport Association (INVA), the American
Volkssport Association (AVA) and the International Volkssport Verband(IVV). The AVA provides
IVV sanctioning of Volkssporting events in the United States.
The Indiana Volkssport Association represents approximately 6 to 8 clubs within the State of
Indiana. The member clubs host more than 40 events annually_
The American Volkssport Association represents more than 450 clubs within the United States.
The member clubs host more than 3,000 events annually.
The International Volkssport Verband represents active Volkssporting organizations in more
than 40 nations.
Volkssporting activities are organized, but non-competitive athletic events that are open to all.
The events offered in the United States include walks, cross-country skiing, biking and
swimming. Participants in these events may receive IVV credit for events and distances
completed. Such information is recorded in an individual's IVV Record Books. After completing
a set number of events and/or distance, individuals may receive awards in recognition of their
achievement.
Since its inception, the Hoosier Hikers has grown to 24 members. It has hosted one to four
Year -Round Events each year for the past 26 years. It has also hosted two one -day
Volkssporting events at Potato Creek State Park for the past 25 years. I n addition to its events
at Potato Creek State Park the, Hoosier Hikers have also hosted one -day events in South Bend,
Mishawaka, Michigan City, LaPorte, Warsaw, Winona Lake, Rochester, Westville and Goshen.
The Hoosier Hikers of South Bend, Indiana, propose to host a six and twelve -kilometer Volksmarch on
public properties in the City of South Bend. The event will be conducted under the auspices of the
American Volkssport Association (AVA)and the International Volkssport Verbund (IVV). The purpose of
the event is to promote health, personal fitness and fellowship through participation in non-competitive
sporting events. The event will be recognized as an IVV sanctioned event, which will allow participants
to earn IVV credit toward IVV event and distance awards.
Participation in the event is open to the public without cost. A fee of $3.00 will be assessed individuals
seeking to receive IVV credit for participation in the event. A fee of $7.00 or $8.00 will be assessed
individuals seeking to receive IVV credit and a special award for participation in the event. Incidental
items, i.e. IVV record books and awards from previous, may also be sold.
A hot or cold beverage and fruit, candy or cookies may be provided without cost to participants at the
start/finish point and at checkpoints along the routes. NO alcoholic beverages will be served or allowed.
The use of tobacco products will be banned in accordance with local ordinances and state law.
The trail routes will start at Seitz Park. The route may be laid -out and marked with signs and engineer
tape, which will be removed upon conclusion of the event. Along the routes up to two checkpoints may
be set-up and operated by members of the Hoosier Hikers. One may be in the vicinity of the East Bank
Trail and Angela Boulevard, and one may be in the vicinity of the entrance to the City Cemetery.
The marking of the route, if done, and set-up of the start/finish and checkpoints will be done the
morning of the event. Participants may start the trail between 11 a.m. and 2 p.m. to be completed by 6
p.m.
All costs for the staging of the event will be borne by the Hoosier Hikers. The Club and its members are
responsible for the set-up, conduct and clean-up associated with the event.
General liability insurance for the event will be provided by United States Eire Insurance Company under
policy numbered SRPGP--101-0716. The City of South Bend, Board of Park Commissioners and South
Bend Venues Parks and Arts are added as additional insureds for this event. Copies of the certificates of
insurance are provided with this request. Participants will also be required to sign a waiver, a copy of
which will be provided upon request.
CERTI
FICATE OF LIABILITY INSURANCE 612212017W1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFpRMATION ONLY AND CONFERS NO RIGI-ITS 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 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
Frazier Insurance Agency, Inc.
P,O Box 1250
Midlothian, VA 23113-1250
EXCLU81ONS AND;CONDITI(7NS OF S'
3R
R TY?E.Of:.(1aSLi4fe�CE
GENERAL LIABITfTY
X CO MYERPI.AL GE7iq LLI .HILYFY
A Coil 55 I.L:DE CCcu,R
X INCLUDES ATHLETIC PARTICIPANT
GE�YL AGGREGATE LIMIT AMLIES PER
x POLICY JECT -.. LOC
AUTOMOBILE LIABILITY
ANYAUTO
ALL OWNED SCHEOULEO
AtiTas AUTOS -
HIREDAUTO NON -OWNED
auroS
UMA'
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EXCESS LIAR cLAla�s.FaADE
OUD RETENTION S
NAMCONTACT Frazier Insurance Agency, Inc.
(A€C, No, Eh): (804) 754-7610 rAx
(wc. Nal: (8Q4} 754-7613
E-MAIL ..
INSURER(S) AFFORDING COVERAGE NA€C S
INsuRERA: United States Fire Insurance Company
21113
INSURERS: United States Fire Insurance Company 1 13
INSURERC:
INSURERD.
INSURERE:
INSURERF:
=> NUMBER. F2EV lS1DN NUMBER:
URANCE LISTED BELOW HAVE BEEN ISSUED TO. THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
aT, TERM :Oft CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY NUMBER " POLICY EFF PDLICY EXP
LIMITS
GENERAL AGGREGATE I $ 2,000,000.00
PRODUCTS COMPIOP AGG
$
2,000,000,00
SRPGP-101-071 t7 PERSONAL & ADV €NJt)RY
1,000.000,00
01/01/2017 01/01/2018 EACH OCCURRENGE
12:01 AM
$
1,000,000.00
FIRE DAMAGE (Anyone rre)
300,000,00
MED EXP (Any one person)
$
-
`'5,000,00
COMBINED SINGLC LIMIT
- (Ea'C' iwapo
$
BODILY INJURY (Per perscn)
S
BODILY INJURY (Per accident)
$
PROPERTYQAM,,,gE
(Per audenp
$
EACH OCCURRENCE $
AGGREGATE 3
3
$
.B Accident/Medical - U5506352 MAXIMUM MEDICAL BENEFIT S 10,000.00
01/01/2017 01/01/2018 ADBD $ 2,500,00
I)ESC12:01AM Per Claim
POLIO DEDUCTIBLE!
TI pE! $0.00 ER LOCATIONSA.BILYVEHICLES(AltachACORn103,AddLAIM.lRengaksschedule.€fmarespaceisrequired)
POLICY DEDUCTIBLE: $p.00 PER F11GFI. BODILY INJURY OR PROPERTY pAMAGE CLAIM.
Event: Walk Location: South Bend, IN Date: 10/22/17
Club: Hoosier Hikers
Certificate Holder is An Additional Insured, But Only As Respects The Operations Of The Named Insured,
CERTIFICATEHOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIFR Flr rAml I
W� � • - - --- -,- -- - . _-..
5'
I
DATE (MMroorYYYY)
CERTIFICATE OF LIABILITY INSURANCE 6/22/2017
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 INSURE.R(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 1NAMPOT Frazier Insurance Agency, Inc.
Frazier Insurance Agency, Inc.
P.O Box 1250
Midlothian, VA 23113-1250
FAX
(Arc. No, EAL (804) 754-7610 1 wc. Noy (804) 754-7613
E-MAiL
ADDRESS- ifrazi
INSURER(S) AFFORDING COVERAGE
INSURERA: United States Fire Insurance Company
NAIL N
21113
INSURED 211 l 3
Spoils &RecrealionProviders Assn. Risk Management.Inc , INSURERB:United States Fire Insurance Company
INSURERC:
American Volksspori.Association, Inc,
1001 Pat Booker Road, Suite 101 INSURERID_
Universal City, TX 78148 INSURERE.
INSURERF:
COUERRGES CERTIFICATENUMBER`. REVISION NUNh3ER: .
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 REEN REDUCED BY PAID CLAIMS-
ISR
rR
,TYPE OF INSURANCE '. ..
ACDL
INSR
5UBR
WVD
POLICY NUMBER
POLICY GFF
(MIAJDDlYYYY)
POLICY EXP
(MwC`OfYYYY)
LIMITS
A
GENERAL LIABILITY
X COVAAaEFFCInLGENERALua&LITY
CLAIMS -MADE Fx] OCCUR.. -
SRPGP-101-0716
01/01/2017
01/01/2018
12:01 AM
GENERA(_ AGGREGATE
$ 2,000,000.00
PRODUCTS • COMPIOP AGG
g 2,000,000.00
PERSONAL& ADV INJURY
$ 1,000,000.00
EACH OCCURRENCE
s 1;a00.a0o.00
K
INCLUDES ATHLETIC PARTICIPANTS
FIRE DAMAGE (Any one fire)
$ 300,000,00
GEMLAGGREGATE LIMIT APPLIES PER:
X POLICY IPE� LOG
MED EXP (Any one person)
$ : 000,00
$
AUTOMOBILE
.. LIABILITY
AtKAUTO
ALLOWNEO -SCHEDULED
AUTOS AUTOS
HIREOAUTO NON -OWNED
AUTOS
COMBINED SINGLE LIA9T
(Ea acddcm)
$
BODILY INJURY (Per pefsonl
$
BODILY INJURY (Per accident)
$
PROPERTYDAMAGE
(P—Oddem)
-
UMBRELLALIAIR
EXCESS LIAR
OCCUR
CLh1ASS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION 5
$
$
B
Accident/Medical
US506352
01/01/2017
01/01/2018
12:01AM
MAXIMUM MEDICAL BENEFIT
ADBD
I
5 10,000.00
$ 2,500,00
Per Claim
DESCRIPTION OF OPERATIONS f LOCATIONSIVEHICLES (AltachACORD 101, AddilionalRemarksSchedule,if more space is required)
POLICY DEDUCTIBLE: $0.00 PER EACH BODILY INJURY OR PROPERTY DAMAGE CLAIM,
Event: Walk Location: South Bend, IN Date: 10/22/17 Club: Hoosier Hikers
Certificate Holder is An Additional Insured, But Only As Respects The operations Of The Named Insured.
CERTIFICATE HOLDER CANCELLATION
South Bend Venues, Parks & Arts
321 B. Walter St.
South Bend, IN 46614
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
John W (Frazier
0 1988-2010 ACORD CORPORATION. All rights reserved.
7D 26 (2010105) Thp Af .nPn names and Innn ara raniafamrl mnrkc of Al nPn