HomeMy WebLinkAboutCertificate of Insurance (3)
At~t.III.., CEBrlf~'iE':ePI:I[:$Q:"~NOt; DATE (MMIDDiYY)
," : .:: "..:' " "';':: ..: '\, '~:::!,: ':: ::'::::;',:; ,\<::~::" .: ,:,~:\,"::' :;: ;::', < ;;' "'",' ,: "':;' ;:~ ::: :~, :;; 06 13 94
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
LUPKE-RICE-CLANCY ASSOCIATES CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVER-
P.O. Box 11309 AGE AFFORDED BY THE POLICIES BELOW.
Fort Wayne, IN 46857 COMPANIES AFFORDING COVERAGE
COMPANY
A St. Paul Mercur Insurance CO.
INSURED COMPANY
USA TRACK & FIELD AND B St. Paul Indemnit Ins. Co.
THE ATHLETICS CONGRESS OF THE COMPANY
USA, INC. C
One Hoosier Dome, Suite 140
Indianapolis, IN 46225
COVI!AASIS'.,.'.'.'c
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 BEEN REDUCED BY PAID CLAIMS.
_.'~-,.._-
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MMiDDiYY) DATE (MMiDDiYY)
GENERAL LIABILITY CiENERAL AGGREGATE $ 2 000 000
A X COMMERCIAL GENERAL LIABILITY CKO 1301 310 12/31/93 1 2/31/94 PRODUCTS COMP/OP AGei, $ 2 000 000
CLAIMS MADE 0 OCCUR I'cl !SONAL & ADV IN,IlJHY $ 1 000 000
OWNER'S & CONT PROT EACH OCCURRENCE $ 1,000,000
--
X LIABILITY ARISING OUT OF FIRE DAMAGE (Anyon" lite) $ 50 000
ATHLETIC PARTICIPATION MED eXP (Anyone person) $ 5000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
A ANY AUTO
ALL OWNED AUTOS EJODIL Y INJURY
(Per Pmson) $
SCHEDULED AUTOS
HIRED AUTOS RODII. Y INJURY
$
NON-OWNED AUTOS (Per accident)
.- PROPFRTY DAMAGE $
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
.-
ANY AUTO OTHER THAN AUl 0 ONLY:
-,~."~,,.~-'--~~'."',' ~._..". ~,._~"._...,._~-
EACt! ACCIDENT $
".~'.',.,
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $ 1,000,000
B X UMBRELLA FORM 513TB3695 1 2/31/93 1 2/31/94 AGGREGATE $ 1,000,000
OTHER THAN UMBRELLA FORM $
WORKER'S COMPENSATION AND STATUTORY LIMITS
EMPLOYERS' LIABILITY .~-----'_..~, ,.."^'.,'",,"--'.' ""."""',"-'",,,~'" ~~"~-~
tACH ACCIDtNT $
THE PROPRIETOR/ INCL DISEASE - POLICY LIMIT $
PARTNERS/EXECUTIVE __._~"'_" _.~___.'"_'"_,.___~_'~__ ."""W'__~~_.'''.~. "__~",__"_.....~",y~
FFICERS ARE: EXCL DIStASE ,. EACH EMPLOYeE $
OTHER
DESCRIPTION OF OPERATIONSiLOCATIONSiVEHICLESiSPECIAL ITEMS
EVENT: First Security Bank Sweet Pea Runs and McDonald's Children's Run
SANCTrON NO. 94-RR14 DATE: August 6, 1994. Certificate Holder is additional insured for
CANCELLATION
City of Bozeman
Attn: Robin Sullivan
P.O. Box 640
Bozeman, MT 59771
I
ACOAD~Mii<3!9$