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Home My WebLink AboutUSA BMXClient#: 1067930 , V U �t )kERIBI 1 i # PATE (MM7DDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 3106MIODN /2024 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: CT Misty Klemme USI Insurance Services LLC PHONE 602-749-4112 A1C No Ell): AIC No 2375 E. Camelback Rd, Suite 250 E-MAIL mist klemme usi.com ADDRESS: y PhnpniY A7 R✓�n'IR INSURED American Bicycle Association dba: USA BMX 1645 W Sunrise Blvd Gilbert, AZ 85233 INSURER(S) AFFORDING COVERAGE NAIC N INSURER A. Philadelphia Indemnity Insurance Co. 18058 INSURER B : INSURER C : I INSURER E : 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADDL 1_N3R SUBR W_ VD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP NIWDDm LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY F1 JECT LOC OTHER: X X PHPK2660213 D310112024 0310112025 EACH $1 000 000 pq��,OCCURRENCE PREMISES (E. occurrence) $100 000 MED EXP (Any one person) s Excluded PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMP/OP AGG $1,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY PHPK2660213 3/01/2024 031011202 BINED Ea aaccidentsINGLELIMIT 9,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLALIAB X OCCUR EXCESS LIAB CLAIMS -MADE PHUB902184 3/0112024 03/01/202 EACH OCCURRENCE s4,000,000 AGGREGATE s4,000,000 DED I X RETENTION $10 000 s WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N 1 A P ,MU= OTH ER $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 107, Addlt onal Remarks Schedule, may be attached It more space Is requEred) RECE4VF0 BY Certificate holder and any other entities listed below are listed as additional insured under the General CAt.OWEF LL,iY rl ERK Liability on a primary S Non Contributory Basis including waiver of subrogation with respect to the American Bicycle Association/USA BMX sanctioned eventslcompetitionslpractices and other operations ,J LJN 1 2024 conducted by American Bicycle AssociationlUSA BMX track operators on behalf of the American Bicycle Association/USA BMX. (See Attached Descriptions) City of Caldwell PO Box 1179 Caldwell, ID 83606-1179 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 O 1988-2015 ACORD CORPORATION. All riahts reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S439830261M43982494 SACT