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4coR CERTIFICATE OF LIABILITY INSURANCE s iaizo s Y' «�. 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 cedi cate 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) Frazier Insurance Agency, Inc. P.O Box 1250 Midlothian, VA 23113-1250 Spats $ Reaeatia, Predrkrs Assn. Risk Management Inc. American Volkssport Association, Inc. 1001 Pat Booker Road, Suite 101 Universal City, TX 78148 Frazier Insurance Agency, Inc. I rArc No E,nt (804) 754-7610 1 (uc. No): (804) 754-7613 INSURER(AS) AFFORDING COVERAGE NAIC# INSURERA: United States Fire Insurance Company 1 21113 INSURERC. INSURERD: INSURERE. INSURERF: :OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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. 11R fR TYPE OF INSURANCE ADDL INSR SUBR MA/ D POLICY NUMBER POLICY EFF (MMIDD/YYYYI POLICY EXP MwopfyWY1 LIMITS A GENERAL LIABILITY X GOMMERMALGENERA UA&LRY OWMs.MADE OCCUR SRPGP-101-0715 01/01/2016 01/01/2017 12:01 AM GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 PERSONALBADV INJURY $ 1,000.000,00 EACH OCCURRENCE $ 1,000,000.00 X INCLUDES ATHLETIC PARTICIPANTS FIRE DAMAGE Arr one fire GENL AGGREGATE LIMIT APPLIES PER: X POLICY JELT LOS MED EXP(Any om pei5rom ,$ 5,000.00 $ AUTOMOBILE LIABILITY ANYAUTO AA�OW/NED SCHEDULED HIREDAUTO NON MINED AUTOS COk1SINEOSINGLE LIMIT IES A«Iaene $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident)) $ PROPERTYDAMAOE (Pe'aW BM) $ $ UMBRELLALIAB EXCESS LIAR oCOUR CIAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION E $ IS $ B Accident/Medical US473485 01/01/2016 01/01/2017 12:01AM MAXIMUM MEDICAL BENEFIT AD$D $ 10,000.00 $ 2,500.00 Per Claim OESCRIFTIONOFOPERATIONS/LOCATIONSIVEHICLES (Attach ACORD 101,Addilional RemarksSGTedule.ifmomspeceisrequimd) POLICY DEDUCTIBLE: $0.00 PER EACH BODILY INJURY OR PROPERTY DAMAGE CLAIM. Event: Walk Location: South Bend, IN Date: 10/23/16 Club: Hoosier Hikers Certificate Holder is. An Additional Insured, But Only As Respects The Operations Of The Named Insured, CERTIFICATE HOLDER CANCELLATION Board of Park Commissioners 321 E. 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 ACORD 25 (2010105) W. Frazier 01988-2010 ACORD CORPORATION. All rights reserved. The At ..r)Pn nnmc and Innn arc rcnicfcruH mcrkR of Cr'.OPr)