Run 2 Be Fit dba PNW Ladies Running Group 12/28/2020

ACfJ R 4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) R17 12/16/2020 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 have ADDITIONAL INSURED provisions or 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 CONTACT Margaret Mayers NAME: Insurance Management Grou PHONE (260)338-2434 FAx (765)664-0761 p AIC,No,EA): (A/C,No): 12730 Coldwater Rd Ste 103 'MAIL mmayers[diinsmgt.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Fort Wayne IN 46845 INSURER A: National Casualty Company 11991 INSURED INSURER B: Nationwide Life Insurance Company 66869 Road Runners Club of America/2020 and Its Member Clubs INSURER C: INSURER D 1501 Lee Highway,Suite 140 INSURER E: Arlington VA 22209 INSURER F: COVERAGES CERTIFICATE NUMBER: 2020$1MA.I. 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM►DD/YYYY) (MM/DD/YYYY) x COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 DAMAGTCLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 500,000 )( Legal Liability to MED EXP(Any one person) $ 5,000 A Participant$1,000,000 KR00000008194100 12/31/2019 12/31/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 PRO- 1,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ X OTHER: Per Event Basis Abuse and Molestation $ 500,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ._.-_.. OWNED SCHEDULED KR00000008194100 12/31/2019 12/31/2020 BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ - AUTOS ONLY - AUTOS ONLY (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ - EXCESS LIAB -__ CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'UABILITY Y/N STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE N 1 A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Excess Medical $10,000 Excess Medical&Accident B ($250 Deductible/Claim) BAX0000031001200 12/31/2019 12/31/2020 AD&Specific Loss $2,500 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Everett,its officers,agents and employees are NAMED AS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE OF EVENT(S): 12/15/20 through 12/31/20 City of Everett Grant Request INSURED RRCA CLUB/EVENT MEMBER: Run 2 Be Fit dba PNW Ladies Running Group,Att'n: Arnie Martinez,3812 High Street,Everett,WA 98201 Attached: PCN 0341-CG2026& KRGL79 Processed by MMM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 12/15/20 City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Westmore Avenue AUTHORIZED REPRESENTATIVE Everett WA 98201 C(ofuA afibits ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD