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——— CAMPCYC-01 NLEMERE -
eS
ACORiI”
CERTIFICATE OF LIABILITY INSURANCE DATE (MMODIVYYY
9/1/2026
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
NAME: a .
B310 Male Sigel ii, en. (716) 634-5097
PHONE
[ EAR. noy(746) 626-5057
Wiliamsville, NY 14221 ADORESS:
INSURER(S) AFFORDING COVERAGE NAIC #
iInsuRER
A: US Underwriters
INSURED insuRER
B : United States Liability 25895 |
Campus Cycling Collective, inc, INSURER ¢ :
744 Elmwood Avenue INSURER D:
Buffalo, NY 14.222
INSUIRER E =
_ __. INSURER F: a
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS 1S 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 1S SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND GONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
WSR] TYPEOF INSURANCE ADDL ISUBR| POLICY NUMBER MOBY) |(MMIDDAYEn . LIMITS .
A | X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE, § 1,000,000
| ccams-made [X ] occur x NPP3553874E 1214/2025 | 1211/2026 |DAMAGETORENTED y ~ 106,000
LMED EXP (Any ene person} $ 5,000
PERSONAL & ADVINJURY [5 4 000, 000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE . $ 2,000, 000
:
_| POLICY PRO-
ECT Loc | PRODUCTSa - COMP/OP AGG ; | $ 1,060,000
we
OTHER: it.
|AUTOMOBILE LIABILITY fe OMBINED S INGLE baat &
ANY AUTO BODILY INJURY [Per person) $
OWNED SCHEDULED
_| AUTOS ONLY AUTOS BODILY INJURY (Per accidengy | $
PROPERTY DAMAGE
= URES onty RORSS ONEY | (Per accident) E
L. $ .
B | XJ] umprewauas | Xj occur EACH OCCURRENCE $ _ 1,000,008
EXCESS HAR CLAIMS-MADE XLIG14792E 1244/2025 | 12/1/2026 AGGREGATE $
pep | X | RETENTIONS Q . ___Is 1,000,000
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS’ LIGBILITY YIN STATUTE LER a
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENTL. __. $..
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH} E.L. DISEASE - EA EMPLOYEE! $ -
if yes, describe under
DESCRIPTION OF OPERATIONS below, ELL. DISEASE - POLICY LIMIT | $
"| DESCRIPTION OF OPERATIONS / LOCATIONS.f VEHIGLES (ACORD 101, Additional Remarks Schedule, may be atfachad if more space Is required}
Town of Aurora is listed as an additional insured.
Event: Knox Farm Cyclocross
Date: 10/11/26
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Aurora ACCORDANCE WITH THE POLICY PROVISIONS.
575 Oakwood Ave
East Aurora, NY 14052 — ——
AUTHORIZED REPRESENTATIVE
(pinta Feties .
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD