2019-021-E Economic Dev - Championship Auto Racing Series tour event sponsorship

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DocuSign Envelope ID:779C2136-AC30-4AF7-8998-13BCEE377BDE AC:CIOIi ff CERTIFICATE OF LIABILITY INSURANCE 7DATE(MM/DD/YYYY) /08/2019 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 Jeff Ladd Sports Insurance Specialists, LLC PHONE 260-969-0305 Fox 260-459-1630 14033 Illinois Rd., Suite A EMAIL ADDRESS-joff@spodslrisurancespecialists.com Fort Wayne IN 46814 INSURERS AFFORDING COVERAGE NAIC* INSpRMA,The American Insurance Company INSURED INSURERB:Firemans Fund Insurance Company Championship Auto Racing Series, LLC. DBA CARS X-1 R National Sure Insurance Company INSURER C: � C P Y 223 Mayfair Rd INSURERD:Axis Surplus Insurance Company Mooresville NC 28117 INSURER E INSURER F 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. INSR A9DL$l7BR YOLIGG EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD M/DD LIMITS A `/ COMMERCIAL GENERAL LIABILITY XPK80985797 03/13/2018 03/13/2019 EACH OCCURRENCE $ 1,000,000 UAMAUE I KLN1tU CLAIMS-MADE ✓ OCCUR PREMISES Ea occurrence $ 100,000 MEDEXP(Any one person $ NC PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 JECTPRO- POI.IG Y 0 LOC PRODUCTS-COMP/OP AGG $5,000,000 ✓ OTHER:Per Event $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ MA ac denl ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) ccident) $ B UMBRELLA LIAB OCCUR XPK80985797 03/13/2018 03/13/2019 EACHOCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ C WORKERS COMPENSATION �SCW0014551801 03/13/2018 03113/2019 STATUTE OTH- AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D D Participant Accident SR2014NC-P-120241 03/13/2018 03/1312019 $10,000 AD&D $50,000 Excess Medical DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) C.Workers Compensation&Employers'Liability:-Excluded Executive Officers: Jack McNally Evidence Of Coverage CERTIFICATE HOLDER CANCELLATION 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 i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software.www.FormsBass.com(c)Imoressive Publishinq 800-20e-1977