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CERTIFICATE OF INSURANCE
<br />AGENCY:
<br />ESIX 3 LLC
<br />d/b /a Entertainment & Sports Insurance eXperts (ESIX)
<br />d/b/a Entertainment and Sports Insurance Agency (Califomia)
<br />2727 Paces Ferry Road, Building Two, Suite 1500
<br />Atlanta, GA 30339
<br />678-324-3300 (Telephone)
<br />678-324-3303 (Facsimile)
<br />NAMED INSURED:
<br />USA Triathlon of Colorado
<br />5825 Delmonico Drive
<br />Colorado Springs CO 80919-2401
<br />EVENT INFORMATION:
<br />DEANNA MULLER
<br />Ellensburg Triathlon (Olympic and Sprint) (7/23/2016 -7/23/2016)
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<br />POLICY/COVERAGE INFORMATION:
<br />DATE: 2/29/2016
<br />CERTIFICATE NUMBER: 20160121399055
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
<br />CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
<br />NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TH E POLICIES
<br />BELOW.
<br />INSURERS AFFORDING COVERAGE:
<br />INSURER A:
<br />, INSURER B:
<br />Everest National Insurance Company
<br />Everest National Insurance Company
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR. THE POLICY PERIOD INDIr:ATED. NOTWITHSTANDING ANY
<br />REQUIREMENT, TER.M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE
<br />INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE
<br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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<br />,INS TYPE OF INSURANCE: . I POLICY NUMBER(S): EFFECTIVE:
<br />A . GENERAL LIABILITY
<br />X Occurrence
<br />X Participant Legal Liability
<br />B UMBRELLA/EXCESS LIABILITY
<br />X Occurrence S18EX00179-151
<br />EXPIRES: LIMITS:
<br />12 /1/2016
<br />12:01 AM
<br />12 /1/2016
<br />,12:01 AM
<br />GENERAL AGGREGATE (Applies Per Event)
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTED PREMISES (Each Occ.)
<br />MEDICAL EXPENSE (Anyone person)
<br />y, V_SY'_~N'Y'~"YY"··"'·V'·' "YYN .Y.'.'···~.~.'·._·Y.YV.V.'·. ,"
<br />PERSONAL & ADV INJURY
<br />PRODUCTS-COMP/OP AGG
<br />EACH OCCURRENCE
<br />AGGREGATE (Applies Per Event)
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<br />AGGREGATE (Policy)
<br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS:
<br />Coverage applies to the USA Triathlon sanctioned or approved event specified on this certificate.
<br />The certificate holder is an additional insured as per form ECG20600: Additional Insured -Automatic Status When Required in a Written Agreement.
<br />The General Liability policy is primary as per Form CG0001.
<br />The General Liability policy contains a Waiver of Subrogation provision as required by written agreement per Form ECG24522.
<br />CERTIFICATE HOLDER: NOTICE OF CANCELLATION:
<br />$1,000,000
<br />$1,000 ,000
<br />EXCLUDED
<br />$1,000,000
<br />$40,000,000
<br />Kilittas County, It's Officers, Officials, Employees
<br />205 W 5th Ave
<br />Should any of the above described policies be cancelled before the expiration date thereof.
<br />notice will be delivered in accordance with the policy provisions.
<br />Ellensburg WA 98926 AUTHORIZED REPRESENTATIVE:
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