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HomeMy WebLinkAboutMadison Dash Cross Country Meet 23 Certificate of Liability Insurance.pdf CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ DD/ YYYY) 05/23/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SADLER & COMPANY, INC. P.O. BOX 5866 COLUMBIA, SOUTH CAROLINA 29250-5866 CONTACT NAME: Sports Dept PHONE (A/ C, No. Ext): 800-622-7370   |   FAX (A/ C, No): 803-256-4017 E- MAIL ADDRESS: amateur@sadlersports.com PRODUCER CUSTOMER ID#: INSURED Rexburg Track Club Inc 162 K St Rexburg, ID 83440-1438 Application ID: 389025 A Member of the Sports, Leisure & Entertainment RPG INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: NATIONWIDE INSURANCE COMPANY 23787 INSURER B: INSURER C: INSURER D: COVERAGES CERTIFICATE NUMBER REVISION NUMBER 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSD LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/ DD/ YYYY) POLICY EXP (MM/ DD/ YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY    CLAIMS MADE   OCCUR ____________________ ____________________ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY   PROJECT   LOC   6B RPG0000007893500 12:01:00 AM ET 06/01/2023 12:01AM ET 06/01/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO PREMISES RENTED TO YOU (Fire Legal Liability)$1,000,000 MEDICAL EXPENSES (other than participants)$5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE (other than Products- completed Operations)$5,000,000 PRODUCTS- COMP/ OP AGG $1,000,000 LEGAL LIAB TO PARTICIPANTS $2,000,000 PROFESSIONAL LIABILITY $1,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS (not provided while in Hawaii) NON- OWNED AUTOS (not provided while in Hawaii)    6B RPG0000007893500 12:01:00 AM ET 06/01/2023 12:01AM ET 06/01/2024 COMBINED SINGLE LIMIT (Ea Accident)$1,000,000 BODILY INJURY (Per person)  BODILY INJURY (Per accident)  PROPERTY DAMAGE (Per accident)       UMBRELLA LIAB   OCCUR EXCESS LIAB   CLAIMS- MADE DEDUCTIBLE RETENTION    EACH OCCURRENCE   AGGREGATE           WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below    N/ A WC STATUTORY LIMITS OTHER   E.L. EACH ACCIDENT   E.L. DISEASE - EA EOMPLOYEE   E.L. DISEASE - POLICY LIMIT   A MEDICAL PAYMENTS TO PARTICIPANTS    6B RPG0000007893500 12:01:00 AM ET 06/01/2023 12:01AM ET 06/01/2024 EXCESS MEDICAL $25,000 AD&D NONE DEDUCTIBLE $100 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: COVERED SPORTS Track and Field (Excluding Javelin & Hammer) 12 & Under, Track and Field (Excluding Javelin & Hammer) 13-15, Track and Field (Excluding Javelin & Hammer) 16-19, High Brain Injury Sports - For Deck/ Floor/ Field/ Street Hockey, Roller Hockey (quad), Cheerleading (age 19 & under); Lacrosse (age 19 & under); Tackle and contact football (age 19 & under), Soccer (age 19 & under), Water Hockey (age 19 & under),Wrestling (age 19 & under), and Umpire/ Referee Associations for the above High Risk Concussion Sports, Limited Coverage for "Brain Injury" endorsement applies- Brain Injury Limit: $1,000,000 occurrence/ $1,000,000 aggregate; Brain Injury Loss Adjustment Expense Limit: $1,000,000 occurrence/ $1,000,000 aggregate. "Brain Injury" means concussion, chronic traumatic encephalopathy, or any other injury to the brain and any symptoms, conditions, disorders and diseases, including death, resulting therefrom but only if such injury occurs as a result of specific events occurring during the policy period. CERTIFICATE HOLDER CANCELLATION EVIDENCE OF COVERAGE 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 Coverage is only extended to U.S. events and activities ** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Y/ N Sadler Sports: Amateur Teams / Leagues Insurance Plan