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Al n" CERTIFICATE. OF LIABILITY INSURANCE Tsage 1 of 2 DATE <br /> ii4/'""/2012 <br /> THIS CERTIFICATE IS ISSUED AS A MATTEROF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the cer ificate holder is aIn ADDITIONAL INSURED,the policy(ies)must be endorsed. ff SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain FmA icles may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorseinent(s). <br /> PRODUCER CONTACT <br /> Nillii of Texas, Inc. NAMP <br /> PHONE FAX <br /> c/o 26 Century Blvd. - 877-945-7378 I tilnp 888-467-2378 <br /> P.O. Hoz 305191 ..�_!ertificates@willis.com <br /> Nashville, TR 37230-5191 - <br /> - DMI <br /> INSURER(S)AFFORGIXNERAGE NAICft <br /> INSURER A;Federal YnaurRace Carpany 20281-001 <br /> 01sIIraD --'------ - <br /> USA Cycling, Ina. INSURER B: <br /> 210 USA Cycling Point INSURERC' <br /> Colorado Springs, CO 80919 - _ <br /> INSURER D: <br /> (INSURER E: - - -- - - — <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:17424122 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANM LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. <br /> INSR1 TYPEOF�ISURANCE — St1 - POLICYNUY R POLICY EFF POLICY EtO) EA <br /> W-�— LIQ^ -- <br /> A GENERALUAMLIFr Y I 79960314 12/31/201112/32/201CH OCCURRENCE _ i 1 ODO DOD <br /> ][ COMMERCIAL GENERALULABIIITY MAGE TORENTED <br /> i I EMFSES& NTEDnce �i I.000 D00 <br /> CLAIMS-MADEOOCCUR + MEDEXP(Anyompemn) <br /> _ — -------- � <br /> PERSONAL aADVINJURY S 1,000 0 0 <br /> GENERALAGC-REGATE <br /> CENIAGGREGATELIMITAPPUESPER I PRODUCTS•COMPMPAGG Z 1,000,000 <br /> I <br /> POLICY PRO LOC I $ <br /> AUTOMOBIIJn LIABILDY i ICOMBNEDI)NGLE LIMB ; <br /> ANYAUTO f i �(E�aOIXY1NJURY(Perperson) i <br /> ALL OWNED SCHEDULED I'86DILYINRY(PeraccideM) S <br /> JU <br /> AUTOS AUTOS <br /> HIREDAUTOS <br /> A NED <br /> :(perecclde.Yrrt) <br /> E UYBRELI�1 LiAB ;OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB i CLANS-MADE AGGREGATE S <br /> DED I RETENTION i <br /> WORKERS COMPENSATION I <br /> ANDEMPLAYERS'LtA=TY YIN• mavi — <br /> ANY PROPRIETORMARTNER(EXECUTNE 7 1•NIA <br /> I I E.L.EACH ACCIDENT S <br /> OfFFICEPWM�SEREXCLUDED? IJ <br /> IfyeS beunA., E.L.DISEASE-EAEMPLOYEF T <br /> ;=PTIONOFOPERATIONS bebw E.LDISEASE-POLICY UNIT jS <br /> � 1 <br /> DESCRIPTIONOFOPERAT}OMSILDCATIGNS1V--..' ES(Nissl.---1H,AddRzandRwnsksSdwdub,Ilmomspm*iorr*M" <br /> Endorsement 80-02-2306: Additional :insured : As required by written contract, certificate holders <br /> are named as additional insured for IDSA Circling sanctioned/peraitted events. <br /> Endorsement 80-02-7403: went Organiser sad/or Promoters are named Insureds. It ahall be a <br /> condition of coverage that all organiser$/promoters for wham coverage is afforded under this policy <br /> execute a USAC event permit application and coverage will be afforded only for the specific event <br /> and dates on the permit. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ALTIMOR®REPRESENTATIVE <br /> T1%6 county of San Joaquin, Tb* State of California <br /> 1810 S. Hazelton95 Ave. 6 / <br /> Stockton, CA 95205 <br />