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Insurance Certificates 2019/20 World Triathlon Corporation dba IronmanClient#: 18607 WORLDEND DATE (MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1/06/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Bouchard Insurance PHONE 727 447-6481 727 449-1267 AIC, Nv, Ext : A1C, No 101 N Starcrest Dr. E-MAILIF cicerts@bouchardlnsurance.com ADDRESS.. L Clearwater, FL 33765 INSURER(S)AFFORDING COVERAGE NAIC# 727 447-6481 Pn 1 d 1 h; 1 d ; I c 18058 INSURED World Triathlon Corporation 3407 W Dr MLK Jr Blvd, Suite 100 Tampa, FL 33607 INSURER A: l a e p la n emnity ns o INSURER B: Continental Casualty Company 20443 INSURER C : HDI Global Ins Co; HDI-Gerling America 41343 INSURER D : 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 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 W SUB WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y PHPK2078820 12/31/2019 12/31/202C EACH OCCURRENCE S1,000,000 CLAIMS -MADE � OCCUR PARE I&STO aEONccTu fence S1,000,000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY S1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY � JECT LOC GENERAL AGGREGATE S 3,000,000 PRODUCTS S3,000,OOO $ OTHER: A AUTOMOBILE LIABILITY PHPK2078820 12/31/2019 12/31/202 EaaB�dunlslNGLELIMIT S13000,000 S X ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY SCHEDULEAUTOS D _ X AUTOS ONLY X NON -OWNED AUTOS ONLY BODILY INJURY (Per accident) PROPERTY DAMAGE ,.,,{Par acrid n S $ S A X UMBRELLA LIAB X OCCUR PHUB706085 '12/31/2019 12/31/2020 EACH OCCURRENCE S10 000 000 AGGREGATE S1 O OOO 000 FEXCESS LIAB CLAIMS -MADE DED X RETENTION S1. 0 00O S I I B WORKERS COMPENSATION AND EMPLOYERS' LIABILETY ANY PROP RIETORIPARTNERfEXECUTIVE Y I N OFFICERIMEMBER EXCLUDED? � (Mandatory In NH] N /A Y 618545149 38/31/2019 08/31/202 X PER T OTH IE E.L. EACH ACCIDENT S1 00O 0O0 E.L. DISEASE - EA EMPLOYEE $1 000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT S1,000,000 B Workers Comp Y 618545152 08/31/2019 08/31/202 See Desc of Ops C Excess Umbrella 18HX1106 '12/3112019 12/31/202 10,000,000 A . Leased/Ren Equip. PHPK2078820 12/31/2019 12/31/202 1,750,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ** Workers Comp Information ** Other States Coverage - Policy# 618545149 California Workers Comp - B 618545152 Effective Date: 08/31/2019 Expiration Date: 08/31/2020 WC Each Accident Limit: $1,000,000 (See Attached Descriptions) Wilt of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 78495 Calle Tampico ACCORDANCE WITH THE POLICY PROVISIONS. La Quinta, CA 92253 AUTHORIZED REPRESENTATIVE JAI/ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1199709/M 1193894 JONSH SAGITTA 25.3 (2016/03) DESCRIPTIONS (Continued from Page 1) WC Policy Limit: $1,000,000 WC Each Employee Limit: $1,000,000 Additional insured status with respect to General Liability per the attached form(s). Waiver of subrogation applies with respect to General Liability and Workers Compensation per the attached form(s). Coverage is primary as respects General Liability and noncontributory per the attached form(s). All of the above are subject to the terms, conditions and exclusions of the policy/policies. 2 of 2 #S1214200/M1214135 DESCRIPTIONS (Continued from Page 1) WC Policy Limit: $1,000,000 WC Each Employee Limit: $1,000,000 Additional insured status with respect to General Liability per the attached form(s). Waiver of subrogation applies with respect to General Liability and Workers Compensation per the attached form(s). All of the above are subject to the terms, conditions and exclusions of the policy/policies. SAGITTA 25.3 (2016/03) 2 of 2 #51199709/M1193894 POLICY NUMBER: World Triathlon Corporation COMMERCIAL GENERAL LIABILITY NAMED INSURED: PHPK2078820 CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ izati ons : Locations Of Covered Operations Where required by Written Contract Where required by Written Contract Information required to complete this Schedule, if not shown above. will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 NAMED INSURED: World Triathlon Corporation POLICY NUMBER: PHPK2078820 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) Where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11 — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injur/' caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 C ISO Properties, Inc , 2004 Page 1 of 1 13 NAMED INSURED: World Triathlon Corporation POLICY NUMBER: PHPK2078820 COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization where required by a written contract that was executed prior to the occurrence of a loss. (If ho entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 0 NAMED INSURED: World Triathlon Corporation POLICY NUMBER: PHPK2078820 COMMERCIAL GENERAL LIABILITY CG 02 24 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Number of Days' Notice 30 (If no entry appears above, information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement.) For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of cancellation, as provided in paragraph 2. of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement, is increased to the number of days shown in the Schedule above. CG 02 24 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 11 NAMED INSURED: world Triathlon Corporation POLICY NUMBER: 618545149 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 00 03 13 (Ed. 4-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION ON WHOSE BEHALF YOU ARE REQUIRED TO OBTAIN THIS WAIVER OF OUR RIGHT TO RECOVER FROM UNDER A WRITTEN CONTRACT OR AGREEMENT. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No Endorsement No. Insured Premium $ Insurance Company Countersigned by r WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement J This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: G-19160-B (11-1997) Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606 c Copyright CNA All Rights Reserved. Lisa Chaudhry From: Samantha Lebron<samanthalebron@Bouchard lnsurance.com> Sent: Monday, January 6, 2020 11:08 AM To: Lisa Chaudhry Cc: Jonni Sherman Subject: RE: Proof of Insurance Coverage (WORLDEND) Follow Up Flag: Follow up Flag Status: Flagged EXTERNAL: This message originated outside of the City of La Quinta. Please use proper judgement and caution when opening attachments, clicking links or responding to requests for information. Good Afternoon Lisa, Due to the holidays, the renewal policy has not been issued yet. Once received, I can forward you the endorsement showing the primary and non-contributory coverage. Please let me know if you have any questions in the meantime. Thank you! Sincerely, Samantha F-1 ] I ❑" �nl�] E N Samantha Lebron I Client Service Representative SamanthaLebron(&Bouchardl nsurance.com Bouchard Insurance, A Marsh & McLennan Agency LLC Company Office: 727-373-2793 1 Fax: 727-449-1267 101 N. Starcrest Drive, Clearwater, FL 33765 www.Bouchard Insurance. corr From: Lisa Chaudhry <LchaudhrV@laquintaca.gov> Sent: Monday, January 06, 2020 12:05 PM To: Jonni Sherman <JonniSherman Bouchardlnsurance.com>; Katie. Haddad@iro_nman.com Subject: RE: Proof of Insurance Coverage (WORLDEND) Thank you, But we are still missing the Primary and Non-contributory for the general liability policy. Lisa Chaudhry I Administrative Technician Community Resources Department City of La Quinta 78495 Calle Tampico I La Quinta, CA 92253 760.777.7106 www.laquintaca.gov www.playinlaquinta.com PLEASE NOTE., City Hall will be closed on December 241 and 25t ; 2019 as well as December 315; 2019 and January IS; 2020 in observance of the holidays. Please plan accordingly for any business needs that might need to be addressed during this time frame. We thank you for your understanding and look forward to seeing you next year! From:]onnisherman@bouchardinsurance.com<ionnisherman@bouchardinsurance.com> Sent: Monday, January 6, 2020 8:36 AM To: Katie. Haddad ironman.corn; Lisa Chaudhry <Lchaudhrv@laquintaca.gov> Subject: Proof of Insurance Coverage (WORLDEND) EXTERNAL: This message originated outside of the City of La Quinta. Please use proper judgement and caution when opening attachments, clicking links or responding to requests for information. At the request of our insured, we are pleased to provide the attached proof of insurance. This document is issued as a matter of information only and confers no rights upon the holder. This document does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy or policies referenced. This document does not constitute a contract between the issuing insurer(s), authorized representative or producer and the holder. If the holder is an additional insured, the policy(ies) must be endorsed. If the holder is a loss payee, certain policies may require an endorsement. 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 holder in lieu of such endorsements. Should you have any questions or need further assistance, please contact us at one of the following email addresses: CLCerts ,Bouchardlnsurance.com for the general certificate team CertificatesLa�Bouchardlnsurance.com if your account manager is one of the following: Paul Ram, Julie Catalano, Robin Staker, Tyler Weinberger or Bri Vaiculevich Condos rr Bouchard1murance.com for all residential condominium or homeowner associations Thank you and have a great day! 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