Certificate of Insurance DATE: 12/4/2012
• CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER: i 20121204130283
AGENCY:
ESIX Entertainment & Sports Insurance eXperts THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
5660 New Northside Drive, Suite 640 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
Atlanta, GA 30328 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
Phone: (678) 324 -3300 Fax: (678) 324 -3303 BELOW.
NAMED INSURED: INSURERS AFFORDING COVERAGE:
USA Track & Field, Inc. Ragnar Events, LLC
132 East Washington Street, Suite 800 INSURER A: Philadelphia Indemnity Ins. Co.
Indianapolis IN 46204
EVENT INFORMATION:
Ragnar Relay Florida Keys (1/4/2013 - 1/5/2013)
POLICY /COVERAGE INFORMATION:
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. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSITYPE OF INSURANCE: !POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS:
A GENERAL LIABILITY
PHPK935580 11/1/2012 11/1/2013�� " ���� " " �����
( X COMMERCIAL GENERAL GENERAL AGGREGATE (Applies Per Event) $3,000,000
LIABILITY 12:01 AM 12:01 AM .__......_.__...__.,..
— — , EACH OCCURRENCE $1,000,000
X Occurrence
DAMAGE TO RENTED PREMISES (Each Occ.) $1,000,000
MEDICAL EXPENSE (Any one person) EXCLUDED
PERSONAL & ADV INJURY $1,000,000
PRODUCTS- COMP /OP AGG $3,000,000
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS:
Coverage applies to USA Track & Field sanctioned events and registered practices, including any directly related activities, such as event set -up and tear -down,
participant check -in and award ceremonies.
The certificate holder is additional insured but only for the liability arising out of the negligence of the named insured, per the following endorsement: Additional Insured
- Certificate Holders (Form PI -AM -002).
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5-1 ' * a\ up(cri6fia
( CERTIFICATE HOLDER: :NOTICE OF CANCELLATION: •
Monroe County BOCC and TDC Should any of the above described policies be cancelled before the expiration date thereof,
1100 Simonton St notice will be delivered in accordance with the policy provisions.
Key West FL 33040 -AUTHORIZED REPRESENTATIVE:
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USA Track & Field, Inc. PI -AM -002 (12/08)
Effective 11/1/2012- 11/1/2013
Policy # PHPK935580
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - CERTIFICATE HOLDERS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SECTION II — WHO IS AN INSURED is amended to include any Certificate Holder, identified as an
additional insured, on a Certificate of Insurance issued by Philadelphia Indemnity Insurance Company or
our authorized representative, but only for liability arising out of the negligence of the named insured.
The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those
limits specified in a contract or agreement. These limits are inclusive of and not in addition to the limits of
insurance shown in the declarations.
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