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Home My WebLink AboutCertificate of Insurance (11) i- II , ~ < j;, l , A4~4tlll." C..l:arIFICAJfJ..........QF.........I.N$"'AAN~15 .0.04429 DATE (MM/DDfYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY LUPKE-RICE-CLANCY ASSOCIATES AND 'cONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVER- P.O. Box 11309 AGE AFFORDED BY THE POLICIES BELOW. Fort Wayne, IN 46857 COMPANII: __A.FFqRDING COVERAGE .-.-...., COMPANY A St. Palllr.Aercury Insurance C(). ---..., ". ._'~~- INSURED COMPANY USA TRACK & FIELD AND B ~_~__,F.'~ullndemnity Ins~_fo. THE ATHLETICS CONGRESS OF THE COMPANY USA, INC. C One Hoosier Dome, Suite 140 ..-.,. Indianapolis, IN 46225 COMPANY 0 COVERAGES 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 POLlCIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ~ ',,~ CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM/DD/Yy) DATE (MM/DDtyY) GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY CKO 1301 683 12/31/96 12/31/97 PRODUCTS-COMP/OP AGG, $ 2,000,000 __ _ ~ CLAIMS MADE ~J OCCUR ....,...-.- _u "... PERSONAL & ADV INJURY $ 1 ,0091.QOO OWNER'S & CO NT PROT EACH OCCURRENCE $ 1,000,000 ---.. X LIABILITY ARISING OUT OF FIRE DAMAGE (Anyone fire) $ ~O)?.QQ ATHLETIC PARTICIPATION MED EXP (Anyone person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO -......---.- ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per Person) ...--.... HIRED AUTOS BODILY INJURY $ NON.OWNED AUTOS (Per accident) . .--. PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ---- 00___' ,".'" ..~_ ANY AUTO OTHER THAN AUTO ONLY: .,.",. EACH ACCIDENT $ ....---- AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ 1 ,99.QJOOO X UMBRELLA FORM GL01300748 12/31/96 12/31/97 AGGREGATE $ 1,0991000 --,~" . OTHER THAN UMBRELLA FORM $ WORKER'S COMPENSATION AND STATUTORY LIMITS EMPLOYERS' LIABILITY .1.....-_.._. ---. EACH ACCIDENT $ -.-----. THE PROPRIETOR/ INCL DISEASE - POLICY LIMIT $ PARTNERS/EXECUTIVE DISEASE - EACH EMPLOYEE $ OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS sanction #31-97-RR First Security Bank Sweet Pea Run 8-2-97 CERTIFICATE HOL.[)Ii!R CANCEL.LATlON City of Bozeman NDEAVOR TO MAIL P.O. Box 640 Bozeman, MT 5977l Attn: Robin Sullivan RPORATION .1993 II I II I -------- J . I .. . ... I A.D.tlll.~~II'II~lell!l~f.I.N$.lJffINr;I' .....Cl...O...S....O..S...S DATE (MM/DD/YY) I 07 24 96 , PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY i AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I LUPKE.RICE-CLANCY ASSOCIATES CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVER. I P.O. Box 11309 AGE AFFORDED BY THE POLICIES BELOW. I Fort Wayne, IN 46857 COMPANIES AFFORDING COVERAGE -- -- I COMPANY I A St. Paul Mercury Insuranc~Co. -" ~'.,'''~'_. INSURED COMPANY I USA TRACK & FIELD AND B .~!:"Paul Indemnity Ins. Co. I THE ATHLETICS CONGRESS OF THE COMPANY I USA, INC. C One Hoosier Dome, Suite 140 .- Indianapolis, IN 46225 I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I 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. I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, . .,..",..,__n ... _ 'n.'.."'_.~,,_.'._._,.__ CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM/DD/YY) DATE (MM/DDfYY) GENERAL LIABILITY GENERAL AGGREGATE n_~_____?' OQ9-,-900 A x COMMERCIAL GENERAL LIABILITY CKO 1301 310 12/31/95 12/31/96 PRODUCTS-COMP/OP AGG. $ 2,000,000 -..-.-... CLAIMS MADE [;] OCCUR PERSONAL & ADV INJURY $ 1 ,000,000 - .. .- -....-- OWNER'S & CO NT PROT EACH OCCURRENCE $ 1,000,000 --. X LIABILITY ARISING OUT OF FIRE DAMAGE (Anyone fire) $ 50,000 -,,'~" ..-- --.. ATHLETIC PARTICIPATION MED EXP (Anyone person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ A ANY AUTO ALL OWNED AUTOS BODILY INJURY '.."'.". (Per Person) $ SCHEDULED AUTOS --,---,-,---~''''_._-,._,. HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per eccldent) $ ..'_~..'r _._.___n.. _._.."..._n___.___ ~- PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ __.,."ft" AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE ... $__1 ,999,990 B X UMBRELLA FORM 513TB3695 12/31/95 12/31/96 AGGREGATE $ 1 JlQ_Q~Q() _____ OTHER THAN UMBRELLA FORM $ WORKER'S COMPENSATION AND STATUTORY LIMITS EMPLOYERS' LIABILITY . ,,-,..,,-,,_._._------_.. EACH ACCIDENT $ THE PROPRIETOR/ INCL DISEASE - POLICY LIMIT $ PARTNERS/EXECUTIVE -...-.--.".-.-.- -------------- OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERA TIONS/LOCA TIONS/VEHICLES/SPECIAL ITEMS Event: Sweet Pea Run, Sanction No. RR16, Date: August 3, 1996 Certificate Holder is additional insured for this sanctioned event. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City of Bozeman ~ DA YS WRITTEN NOTICE TO THE CERTIFI E HOLDER NAMED TO THE LEFT, Attn: Robin Sullivan P E NO 0 ATION OR LIABILITY P.O. Box 640 REPRESENTATIVES. Bozeman, MT 59771 -------_._--~~_.._- -