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ATE CERTIFICATE OF LIABILITY INSURANCE D6114/2016 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). Frazier Insurance Agency, Inc. P.O Box 1250 Midlothian, VA 23113-1250 INSURED Sports& Reaealion Prooders Assn Risk Management, Inc American VolkssportAssociation, Inc. 1001 Pat Booker Road, Suite 101 Universal City, TX 78148 Frazier Insurance Agency, Inc. I'rwc H„ PSIY (804) 754-7610 I iac. NO (804) 754-7613 INSURER($) AFFORDING COVERAGE NAIC# INSURERA: United States Fire Insurance Company 21113 INSURERC: NSURERD. INSURERE: INSURERF: ,';OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: -HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD !NNCATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEP'IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EACLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADM IJSR SUBR YWD POLICY NUMBER POLICY EFF MWDO/YYYYI POLICY E%P MMIDD�YYYY) LIMITS A GENERAL LIABILITY X DOMMERDIALGENERALLIABILITY CIAIMSMADE InOCCUR SRPGP-101-0715 01/01/2016 01/01/2017 12:01 AM GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG s 2,000,000.00 PERSONAL &AOV INJURY $ 1,000,000.00 EACH OCCURRENCE a 1,000,000.00 X INCLUDES ATHLETIC PARTICIPANTS FIRE DAMAGE (Any One fire) $ 300,000.00 GENLAGGREGATELIMRAPPLIES PER'. X POLICY PRP LOC JECT MED EXP(My.". person) $ 5,000.00 $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED ALROS AUTOS HIREOAUTO n NON-MNED AUTOS OCN&NED$INGLE LMiT IEa arudvnl) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYOAWGE (Pere odl.') $ $ UMBRELLALIAs EXCESS LIAB Occur CLAIM&MADE EACH OCCURRENCE S AGGREGATE $ DED RETENTION $ $ $ B Accident/Medical US473485 01/01/2016 01/01/2017 12:01 AM MAXIMUM MEDICAL BENEFIT AD&D $ 10,000.00 $ 2,500.00 Per Claim DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (Aflsch AGORD 101, Additional Rema?Us Schedule. if mote space is required) 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 South Bend Parks & Recreation Dept. 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 (2010/05) yohnW.. `Frazier 01988-2010 ACORD CORPORATION. All rights reserved. The Gr.01?n n�mc anH Innn am rcnicturoH mark. of G(.nPn