2019-115-Visitor Bureau-Championship Auto Racing series dba cars tour

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DocuSign Envelope ID : 779C2136-AC30-4AF7-8998- 13BCEE377BDE CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYI ) 01 /08/2019 1 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. j 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 NAME: Jeff Ladd Sports Insurance Specialists , LLC PHONE 260 -969-0305 ha ; 260 -459-1630 14033 Illinois Rd . , Suite A EMAIL ADDItESSo , jeff@sportsinsurancespecialists . com Fort Wayne IN 46814 INSURER s AFFORDING COVERAGE NAIC # INSURERA , The American Insurance Company INSURED Firemans Fund Insurance Company INSURER B : P Y Championship Auto Racing Series , LLC . DBA CARS X-1 R National Sure Insurance Company INSURER C : y 223 Mayfair Rd tNSURERD : Axis Surplus Insurance Company Mooresville NC 28117 INSURER E : i , 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 . 1NSR AD L UOR POLICY EFF POLICYEXP LTR TYPE OF INSURANCE ,men umr% POLICY NUMBER ( ._MIDt1JYYYYI ( ._MIDD/YYYYI LIMITS A COMMERCIAL GENERAL LIABILITY XPK80985797 03/13/2018 03/13/2019 EACH OCCURRENCE $ 1 , 000, 000 CLAIMS-MADE Q OCCUR A 1OO 000* PREMISES (Ea occurrence $ , MED EXP (Any one person) $ NC PERSONAL B ADV INJURY $ 10000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5 , 000, 000 P01.1GY ❑ JE° LOC PRODUCTS - COMP/OP AGG $ 5 , 000 , 000 OTHER: Per Event $ AUTOMOBILE LIABILITY COM aaddani SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ LY AUTOS AUTOS ON HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ B UMBRELLA LIAB OCCUR XPK80985797 03/13/2018 03/13/2019 EACH OCCURRENCE $ 3, 000, 000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 3, 000, 000 DED RETENTION $ $ C WORKERS COMPENSATION SCW0014551801 03/13/2018 03113/2019 �TPRiTUTE OTTH- AND EMPLOYERS' LIABILnY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ 1 , 000, 000 OFFICER/MEMBEREXCLUDED? ry] NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 13000, 000 If DESCRIPTION OF OPERATIONS belowyes, describe under D E.L. DISEASE - POLICY LIMIT $ 1 , 000 ► 000 D Participant Accident MSR2014NC-P - 120241 03/13/2018 03/13/2019 $ 103000 ADBD $50,000 Excess Medical DESCRIPTION OF OPERATIONS I 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 McNelly 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 © 19884015 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) Impressive Publishinq 800-20801977