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CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY} <br />0211912020 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELYAMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />lMPoRTANTlfthecertificateholderisanADDlTloNALlNsURED,thepoticy(ie <br />lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />McKay lnsuranceAgency, lnc. <br />106 East Main Street <br />P O Box 151 <br />Knoxville lA 50138 <br />(641)35 (641) 528-2013 <br />meg@mckayinsagency.com <br />INSURER(SI AFFORDING COVERAGE NAIC # <br />tNsuRERA: Evanston lnsurance Company 35378 <br />INSURED <br />Silent Sports Association-NBTS SE <br />Mcious Cycle Events, lnc. ' <br />139 E. Street SW <br />Ephrata wA 98823 <br />tNsuRER B . Gerber Life lnsurance Gompany 70939 <br />INSURER C <br />INSURER D <br />INSURER E: <br />INSURER F <br />CERTIFICATE NUMBER:REVISION NUMBER: <br />INDICATED, NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO ffiICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONSANO CONDITIONS OF SUCH POLICIES. LIMITS SHO\^AI MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INSR <br />LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER <br />FVLIUI ETF <br />LlllilTS <br />EACH OCCURRENCE $ 1,000,000 <br />$ 300,000 <br />MED EXP (Anv one oerson)$ Excluded <br />PERSONAL&ADV INJURY $ 1,000,000 <br />GENERALAGGREGATE $ 2,000,000 <br />PRODUCTS - COMPiOPAGG $ 2,000,000 <br />A <br />COMMERCIAL GENERAL LIABILITY <br />GEN'LAGGREGATE LIMIT APPLIES PER:[]ffsi f <br />CLAIMS-IUADE <br />lncludes Athletic <br />orHER. Event <br />POLICY LOC <br />lXlo."r* <br />Participants <br />N 3607AH01 0099-2 0611412020 06t15t2020 <br />$ <br />$ <br />BODILY INJURY (Per person)$ <br />BODILY INJURY (Per accident)$ <br />$ <br />ANYAUTO <br />OWNED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />NON-OVVI{ED <br />AUTOS ONLY <br />AUTOMOBILE LIABILITY <br />$ <br />EACH OCCURRENCE $ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAII/|S-MADE AGGREGATE s <br />DFI)RETENTION $s <br />I PERI srATr rrF UIH- <br />FR <br />E.L, EACHACCIDENT s <br />E.L. DISEASE - EA EMPLOYEE $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILIry <br />ANY PROPRI ETOR/PARTNER/EXECUTIVE <br />OFFICER/IVIEMBER EXCLUDED? <br />(Mandatory in NH) <br />lf yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />Y/N <br />N/A <br />E.L. DISEASE - POLICY LIIUIT <br />B <br />Accident Medical <br />1 5-070944-1 I 0611412020 06t15t2020 <br />Excess <br />Deductible $250 <br />$25,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />GranFondoEllensburg: June14,2020. KittitasCounty,itsofficersandemployeesareadditional insuredbutontywithrespecttoliabilityarisingoutofthe <br />operationsoftheabovenamedinsured. "Thispolicyisissued,pursuanttolowaCodesection5l5.l4T,byanonadmittedcompanyinl6waandassuchis <br />not covered by the lowa lnsurance Guaranty Association." <br />HOLOER CA <br />O 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN <br />ACCOROANCE WITH THE POLICY PROVISIONS.Kittitas County <br />205 \r'( sth Ave <br />wA 98926Ellensburg <br />I <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03)