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Home My WebLink AboutAMERICAN BICYCLE ASSOCIATION (EPIC BMX) - INSURANCE CERTIFICATE (2)ACOR& CERTIFICATE OF LIABILITY INSURANCE '°'D°""""' rz8rzU 26rm1 s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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 pal icy(les) 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 endorsemen s . PROWLER USI Of Southern CA Insurance Services Inc DBA Wick Pilcher Insurance, Inc 2201 East Camelback Road, Suite 220A ACT NAME, Catlina Daza-Obre on _ PHONE Ea FM 602-279-5800 a NA:602-279-5899 nI ORIFBs:Obre on wick ilchedns.com INSURERS AFFORDING COVERAGE NAIC $ Phoenix AZ 85016 INSURER A:Philadel hia Indemnity Ins. Co I INSURED IAMERI-4 INSURER B: INSURER C: American Dicycle Association P.O. Box 718 L I L P'1X Chandler AZ 85244 INSURER D: INSURER E: INSIIYFN L COVERAGES CERTIFICATE NUMBER: 764351616 REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER MMNaWY MMNDYYYYP LIMITS A GENERAL LVIBILDY X COMMERCIAL GENERAL LIABILITY CIAIM314A➢E F1 OCCUR Y Y PHPK986892 /12D13 112014 EACH OCCURRENCE S1,000.000 S1DO,OOD MED EXP ma Pesw) $EXduded PERSONAL &ADV INJURY $1.000,000 CENEM ACCncc Tn $6,000,000 GENL AGGREGATE LIMIT APPLIES PER X POLICY PRa LOC PRODUCTS - COMP/OP AGO $1,000,000 Abuse/Molestation S1,000,000 A AUTOMOBILE UABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X MIRED AUTOS X AUTOS PHPK986892 3112013 31112014 (Ee scademl BODILY INJURY(P. Pelson) $1.000,000 $ BODILY INJURY (Per amciant) S PROPERTY DAMAGE Psracadenl $ E A X UMBRELLA UAB EXCESS use X OCCUR CLAMS-L1ADE Y Y 78824363 3112013 31112014 EACH OCCURRENCE $4,000,000 AGGREGATE S4,000,000 DEO I I 2 TEITTIONS S WORKERS COMPENSATION AND EMPLOYERS' UABUTY ylN ANY FROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERMEMBER EXCLUDED? M INaatory In NH) Itdasaibe Mtic DESCRIPTION OF OP ERATIONS below NIA WC STATL} OTH- ITORYL ITS E.L. EACH ACCIDENT S E. L. DISEASE - EAEMPLOYE $ E.L. DISEASE- POLICY LIMIT 1 $ DESCWPMMN OPERAnONSILOCAnONSIVEHICLES (Attach ACORD 101, AddKbnal Remarks BLledWe, Ifmore."ca Is ragWrad) Certificate holder and any other entities listed below are listed as additional insured under the General Liability on a primary & Non Contriburoty Basis inducting waiver of subrogation with respect the American Bicycle Association / USA BMX sanctioned events/competitions/practices and other operations conducted by American Bicycle Association / USA BMX track operators on behalf of the American Mcle Association / USA BMX per attached forms PIMANUI 0100. Re: Epic BMX Cittyy of Ft. Collins P. Box 580 Ft. Collins CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUIHDW LUNHmESENIAnve %)1988.2010 AGORO CORPORA I ION. All ngnts mservea- ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD PI-MANU-1 (01/00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Addional Insured/Waiver of Subrogation/Primary & Non -Contributory THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED: OWNERS AND / OR LESSORS OF PREMISES, LESSORS OF LEASED EQUIPMENT, SPONSORS OR CO -PROMOTERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This policy is amended to include as an additional Insured any person or organization of the types designated below, but only with respect to liability arising out of your operations: 1. Owners and / or lessors of the premises leased, rented, or loaned to you, subject to the following additional exclusions: a. This insurance applies only to an "occurrence" which takes place while you are a tenant in the premises; b. This insurance does not apply to "bodily injury" or "property damage" resulting from structural alterations, new construction or demolition operations performed by or on behalf of the owner and / or lessor of the premises; C. This insurance does not apply to liability of the owners and / or lessors for "bodily injury" or "property damage" arising our of any design defect or structural maintenance of the premises or loss caused by a premises defect. With respect to any additional insured included under this policy, this insurance does not apply to the sole negligence of such additional insured. 2. Lessor of Leased Equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" canned, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s) subject to the following additional exclusions: a. This insurance does not apply to any "occurrence" which taken place after the equipment lease expires. 3. Sponsors All other terms and conditions of this Policy remain unchanged. Page 1 of 2 PI-MANU-1 (01/00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY 6. Co -Promoters THIS INSURANCE IS PRIMARY, WITH ANY INSURANCE OR SELF-INSURANCE PROGRAM MAINTAINED BY THE NAME OF PERSON OR ORGANIZATION LISTED ABOVE BEING NON-CONTRIBUTING EXCEPTING LOSS RESULTING FROM THE SOLE NEGLIGENCE OF THE NAME OF PERSON OR ORGANIZATION LISTED ABOVE BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is agreed that, notwithstanding anything to the contrary in paragraph 8. Transfer of Rights of Rccovoty Against Othors To Us of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, in the event of any payment under this policy, we waive our right of recovery against any person or organization with respect to which the Insured has waived its right of recovery. It is further agreed that work commenced under letter of intent or work order, subject to subsequent reduction to writing, with customers whose customary contracts would require a waiver of recovery rights against them also falls within this blanket waiver of subrogation. All other terms and conditions of this Policy remain unchanged. Page 2 of 2