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Home My WebLink AboutInsurance CertificateCOVERAGES CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NUMBER:I 922555858 REVISION NUMBER: DATE (MM/DD/YYYY} 0212512019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELYOR NEGATIVELYAMEND, EXTENO ORALTERTHE COVERAGEAFFORDED BYTHE POLICIES BELOW. TH|S CERTTFICATE OF TNSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE TSSUTNG TNSURER(S), AUTHORTZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANï lf the cert¡f¡cate holder is an ADDITIONAL INSURED, the pol¡cy(¡es) must have ADDITIONAL INSURED prov¡s¡ons or be endorsed. lf SUBROGATION lS WAIVED, subject to the terms and cond¡tions of the policy, certa¡n pol¡c¡es may require an endorsement. A statement on th¡s cert¡f¡cate does not confer r¡ghts to the certificate holder in lieu of such endorsement(s). fiXilf'' Meg Stanley meg@mckayinsagency.com (641) 828-2013(641) 842-2135 INSURERIS) AFFORDING COVERAGE NAIC # PRODUCER McKay lnsuranceAgency, lnc. 106 East Main Street P O Box 151 Knoxville lA 50138 tNsuRERA : Evanston lnsurance Company 35378 tNsuRER B . Gerber L¡fe lnsurance Company 70939 INSURER C INSURER D INSURER E Silent Sports Association-NBTS SE Vìcious Cycle Events, lnc. 139 E. Street SW Ephrata wA 98823 INSURED INSURER F : 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 WTH RESPECT TO \AiI.IICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOIVN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE INSD POLICY NUMBER POLIGY EFF IMM/DD/YYYYI IMM/DD/YYYYI LIMITS A COMM ERCIAL GENERAL LIABILITY clArrrs-iirADE lX o."r" lncludes Athletic Participants LIMITAPPLIES PER: 5F3; l-1,o"POLICY orHER. Event N 36074H01 0099-1 06t16t2019 06117 t2019 EACH OCCI.JRRFNCF s 1,000,000 u tvt^þtr tuKtrtItÈu PPFMIStrS f Fâ ô..,úrÞñ¡ô\$ 300,000 ÀrED EXP lAnv onê oersonl , Excluded PERSONAL&ADV INJURY s I,000,000 GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABIUry ANYAUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON.O\ANED AUTOS ONLY $ BODILY INJURY (Per person)$ BODILY INJURY (Per accident)$ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAI¡J]S.MADE EACH OCCURRENCE $ AGGREGATE $ DFD RETENTION $$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRI ETOR/PARTN ER/EXECUTIVE OFFICER/MEIVBER EXCLUDED? (Mandatory ¡n NH) lf yes, describe under DESCRIPTION OF OPERAïIONS below N/A PER STATI ITF urn- FR E.L, EACH ACCIDENT s E.L, DISEASE - EA EMPLOYEE s E.L. DISEASE. POLICY LIMIT I B Accident Medical 15-070944-18 06/1 6/201 I 0611712019 Excess Deductible $250 $25,000 DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES (ACORD101,Add¡tionalRemarksSchedule,maybeattached¡fmorespace¡srequ¡red) GranFondoEllensburg: June16,2019. Kitt¡tasCounty,itsofficersandemployeesareanadditional insuredbutonlywithrespecttoliabilityar¡singoutofthe operationsoftheabovenamedinsured. "Thispolicyisissued,pursuanttolowaCodesection5l5.l4T,byanonadmittedcompany¡nlowaandassuchis not covered by the lowa lnsurance Guaranty Associat¡on." HOLDER @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ÈXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVIS¡ONS. wA 98926Ellensburg Kittitas County 205 W Sth Ave AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) POLICY NUMBER:3607AHO10099 - I COMMERCIAL GENERAL LIABILITY cc 20 1204 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision Kittitas County, its officers and employees 205 W 5th Ave Ellensburg, WA 98926 lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations A. Section ll - Who ls An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your be- half for which the state or governmental a- gency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permit- ted by law; and b. lf coverage provided to the additional in- sured is required by a contract or agree- ment. the insurance afforded to such ad- ditional insured will not be broader than that which you are required by the con- tract or agreement to provide for such ad- ditional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arisingout of operations performed for the fed- eral government, state or municipality; or b. "Bodily injury" or "property damage" in- cluded within the "products-completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section lll - Limits Of Insurance: lf coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of ln- surance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cable Limits of lnsurance shown in the Decla- rations. lnsured: Silent Sports Association - NBTS SE Vicious Cycle Events, lnc. 139 E. Street SW, Ephrata, WA 98823 Event: Gran Fondo Ellensburg: June 16,2019 CG 20 12 0413 Copyright, lnsurance Services Office, lnc., 2012 Page 1 of 1