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CERTI <br />FICATE OF LIABILITY INSURANCE 612212017W1 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFpRMATION ONLY AND CONFERS NO RIGI-ITS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Frazier Insurance Agency, Inc. <br />P,O Box 1250 <br />Midlothian, VA 23113-1250 <br />EXCLU81ONS AND;CONDITI(7NS OF S' <br />3R <br />R TY?E.Of:.(1aSLi4fe�CE <br />GENERAL LIABITfTY <br />X CO MYERPI.AL GE7iq LLI .HILYFY <br />A Coil 55 I.L:DE CCcu,R <br />X INCLUDES ATHLETIC PARTICIPANT <br />GE�YL AGGREGATE LIMIT AMLIES PER <br />x POLICY JECT -.. LOC <br />AUTOMOBILE LIABILITY <br />ANYAUTO <br />ALL OWNED SCHEOULEO <br />AtiTas AUTOS - <br />HIREDAUTO NON -OWNED <br />auroS <br />UMA' <br />ac-UR <br />EXCESS LIAR cLAla�s.FaADE <br />OUD RETENTION S <br />NAMCONTACT Frazier Insurance Agency, Inc. <br />(A€C, No, Eh): (804) 754-7610 rAx <br />(wc. Nal: (8Q4} 754-7613 <br />E-MAIL .. <br />INSURER(S) AFFORDING COVERAGE NA€C S <br />INsuRERA: United States Fire Insurance Company <br />21113 <br />INSURERS: United States Fire Insurance Company 1 13 <br />INSURERC: <br />INSURERD. <br />INSURERE: <br />INSURERF: <br />=> NUMBER. F2EV lS1DN NUMBER: <br />URANCE LISTED BELOW HAVE BEEN ISSUED TO. THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />aT, TERM :Oft CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />POLICY NUMBER " POLICY EFF PDLICY EXP <br />LIMITS <br />GENERAL AGGREGATE I $ 2,000,000.00 <br />PRODUCTS COMPIOP AGG <br />$ <br />2,000,000,00 <br />SRPGP-101-071 t7 PERSONAL & ADV €NJt)RY <br />1,000.000,00 <br />01/01/2017 01/01/2018 EACH OCCURRENGE <br />12:01 AM <br />$ <br />1,000,000.00 <br />FIRE DAMAGE (Anyone rre) <br />300,000,00 <br />MED EXP (Any one person) <br />$ <br />- <br />`'5,000,00 <br />COMBINED SINGLC LIMIT <br />- (Ea'C' iwapo <br />$ <br />BODILY INJURY (Per perscn) <br />S <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTYQAM,,,gE <br />(Per audenp <br />$ <br />EACH OCCURRENCE $ <br />AGGREGATE 3 <br />3 <br />$ <br />.B Accident/Medical - U5506352 MAXIMUM MEDICAL BENEFIT S 10,000.00 <br />01/01/2017 01/01/2018 ADBD $ 2,500,00 <br />I)ESC12:01AM Per Claim <br />POLIO DEDUCTIBLE! <br />TI pE! $0.00 ER LOCATIONSA.BILYVEHICLES(AltachACORn103,AddLAIM.lRengaksschedule.€fmarespaceisrequired) <br />POLICY DEDUCTIBLE: $p.00 PER F11GFI. BODILY INJURY OR PROPERTY pAMAGE CLAIM. <br />Event: Walk Location: South Bend, IN Date: 10/22/17 <br />Club: Hoosier Hikers <br />Certificate Holder is An Additional Insured, But Only As Respects The Operations Of The Named Insured, <br />CERTIFICATEHOLDER <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIFR Flr rAml I <br />