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CERTIFICATE OF LIABILITY INSURANCE <br />CERTIFTCATENUMBER: CL2142759446 REVISION NUMBER: <br />DATE (MM/DD/YYYY} <br />a4t2712021 <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />LY <br />ALTERNEGATIVELY <br />THISHOLDER.CERTIFICATEpoNTHERIGHTSNOUONANDCONFERSISSUEDtsAASOFMAfiERINFORMATIONCERTIFICATETHISTHEBY POLIC|ESAFFORDEDCOVERAGEOREXTENDTHEORNOTDOESAFFIRMATIVELYAMEND,CERTIFICATE AUTHORIZEDISSUINGATNSURER{S},THEBETWEENCOI{TRACT <br />endorsed.orhavetheINSURED,rsholder ancertificate statemeA onntendorsement.ancertainthetoandtermsofthepoliciesrequrr€mayconditionstspolicY,SUBROGATION WAIVED,subjectlf <br />to the certificate holder in lieu of suchthis certificate does not confer <br />Stanley <br />(M1) 828-2013(641' 842-2135 <br />meg@mckayinsagencY.com <br />NAIC #AFFOROII{G CQVERAGE <br />35378tNsuRERA: Evanston lnsurance Company <br />PRODUCER <br />McKay lnsurance Agency, lnc. <br />,106 East Main Street <br />P O Box 151 <br />Knoxville tA 50138 <br />70s39B. Gerb€r Life lnsurance ComPanY <br />INSURER C <br />INSI,,IRER D : <br />INSURER E <br />F: <br />Silent Sports Association-NBTS SE <br />Mcious Cycle Events, lnc. <br />139 E. Street SW <br />Ephrata wA 98823 <br />INSURED <br />COVERAGES <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />THEFOR PERIODPOLICYTHETONAMEDINSUREDABOVESELOWLISTEDBEENHAVEISSUEDTHETHATOFPOLICIESINSURANCEtsTHTOCERTIFYWHICH1'O THISOTHERORWITHDOCUMENTRESPECTORTERMOFCONDITIONCONTRACTREOUIREMENT,ANYNOTWITHSTANDINGINOICAIEO.THEAILtsHEREINTO TERMS,SUBJECTTHEBYPOLICIDESCRIBEDMAYINSURANCETHEAFFORDEDMAYCERTIFICATEISSUEDORPERTAIN, <br />EXCLUSIONS <br />LIMITSPOLICY NUMBERTYPE OF INSURANCE <br />EACH OCCURRENCE <br />300,000 <br />ExcludedEXPone <br />1.000,000E ADV <br />2,000,000 <br />2,000,000 <br />$ <br />a6t20t2021a6t19t2021N3607AH01009s-3 <br />COMMERCIAL GENERAL LIABILITY <br />cLArMs-MAoE lxl o""r* <br />lncludes Aihletic Participants <br />POLICY <br />PRGJECT I I <br />LIMITAPPLIES PER: <br />Loc <br />A <br />I <br />BODILY INJURY (Per Person) <br />BOOILY INJURY (Per accidenq <br />$ <br />$ <br />ANY AU'O <br />OWNED <br />AU|OS ONLY <br />HIRED <br />AUIOS ONLY <br />NON.OWNED <br />AUTOS ONLY <br />AUTOMOBILE LIAAILITY <br />SCHEDULCO <br />AUTOS <br />OCCURRENCEOCCURUMBRELLA LIAB <br />EXCESS LIAB <br />E-1, EACH <br />sE.L. <br />LIMITE.L <br />N/A <br />AND EMPLOYERS' UABILITY YTN <br />1n <br />lfyes, describe <br />DESCRIPTION below <br />EXCLUDED? <br />COMPENSATION <br />$25.000Excess <br />Deductible $250a6/19t2021 06t20t242115-070944-24B <br />Accident Medical <br />Gran Fondo Ellensburg: June 1g, 2021 " Certificate holder is an additional insured but only with respect to liability arising out of ihe operations of the above <br />namedinsured. "Thispolicyisissued,pursuannolowacodesection5l5.l4T,byanonjdmittedcompanyinlOWaandassuchisnotcoveredbythelowa <br />lnsurance Guaranty Association." <br />DESCRIPTION OF OPERATIONS , LOCATIONS , VEIIICLES {AGoRD 101' Additional Remark6 Schedule, may be attached ;f mote spa* ie Gqsi.ed) <br />SHOULO ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRA]TON DATE T}IEREOF, NOTICE WILL BE DELIVEREO IN <br />ACGORDANCE WITH THE POLICY PROVISIONS. <br />AUT}IORIZED REPRESEHTATIVE <br />wA 98926Ellensburg <br />Kittitas County <br />205 W- 5th Ave <br />@ 1988-2015 ACORD <br />ACoRD 25 (20r6103)The ACORD name and logo are register€d marks of ACORD <br />CORPORATION.All rights reserved.