Ellensnburg Tri Special Event Application

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CERTIFICATE OF INSURANCE AGENCY: Integro USA Inc_ i d/b/a Integro Insurance Brokers 2727 Paces Ferry Road, Building Two, Suite 1500 Atlanta, GA 30339 678-324-3300 (Phone), 678-324-3303 (Fax) NAMED INSURED: PRINT DATE: 12/14/2017 CERTIFICATE NUMBER: 201 71 21 4577249 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE: USA Triathlon of Colorado DEANNA MULLER INSURER A: Philadelphia Indemnity Ins Co. NAIC #: 18058 5825 Delmonico Drive Colorado Springs CO 80919-2401 INSURER B: Philadelphia Indemnity Ins. Co. NAIC #: 18058 EVENT INFORMATION: Ellensburg Triathlon (Olympic and Sprint) (7/14/2018 - 7/14/2018) J POLICY/COVERAGE INFORMATION: 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 I HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL I HL TERMS, EXCLUSIONS ANL' CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IN$ TYPE OF INSURANCE; POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS: A GENERAL LIABILITY X Occurrence PHPK1738697 12/1/2017 12/1/2018 GENERAL AGGREGATE (Applies Per Event) $2,000,000 12:01 AM 12:01 AM _ X Participant Legal Liability EACH OCCURRENCE $1,000,060 DAMAGE TO RENTED PREMISES (Each Occ.) $1,000,000 MEDICAL EXPENSE (Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 PRODUCTS-COMP/OP AGG $2,000,000 B UMBRELLA/EXCESS LIABILITY X Occurrence PHUB607478 12/1/2017 1211/2018 EACH OCCURRENCE $10,000,000 12:01 AM 12:01 AM _ _ AGGREGATE $10,000,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLF-S1EXCLLiSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS: The ceilificate holder is an additional insured, where requnod by written contract or wtitten agreomont, but only with respect to the aperatlorls of the named insured, and subject to liya provWons and limitations of form CG2026 - Additional Insured - Dosignaled Person or Organization, W1 only with respect to the VSAT sanctioned or approved event spni=fied on this eettlfidate The General Liability policy is primary as per Fo,m CG0001 (04/13), The General Liability policy contains Form CG2404 (05/09): Waiver of Transfer of Rights of Recovery Against Others to US, but only as required by written contract or i agreement executed by the named insured prior to an occurrence resulting in a loss or a claim, CERTIFICATE HOLDER: Kitittas County, It's Officers, Officials, Employees 205 W 5th Ave Ellensburg WA 98926 NOTICE OF CANCELLATION: 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: