2014-402 Finance - Bridge II Sports - Outside Agency Performance Agreement $2,500

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AXIS 8000(08/10) CERTIFICATE OF INSURANCE 07/07/2014 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY American Specialty Insurance&Risk Services,Inc. OR NEGATIVELY AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 142 North Main Street BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND Roanoke,Indiana 46783 THE CERTIFICATE HOLDER INSURED INSURERS AFFORDING COVERAGE Disabled Sports USA,Inc. BRIDGE II SPORTS INS A. AXIS Insurance Company 451 Hungerford Drive,Suite 100 INS B• Rockville,MD 20850 INS C CERT NUMBER. 1001170769 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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. INS POLICY POLICY POLICY LTR TYPE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS General Aggregate -Per Chapter 3,000,000 GL AXGL05101976-13 12/01/2013 12/01/2014 Prod ucts-Com feted Operations Aggregate 3,000,000 A Personal and Advertising Inaury 1,000,000 12:01 a.m. 12:01 a.m. Each Occurrence 1,000,000 Damage to Premises Rented to You(Any One Premises 300,000 Medical Expense Limit(Any One Person Excluded Each Occurrence 5,000,000 XS AXXS05100447 13 12/01/2013 12/01/2014 General Aggregate-Per Chapter 5,000,000 A 12:01 a.m. 12:01 a.m. I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The Certificateholder is only an additional insured with respect to liability caused by the negligence of the Named Insured as per Form AXIS 1003-Additional Insured-Certifcateholders, but only with respect to the WHEELCHAIR BASKETBALL YOUTH AND ADULT from July 07 2014 through November 30,2014. Coverage available under policy#SRPO-50219-203 is on file with the policyholder Excess Accident Medical for Class 1&Class 2 is$25,000 with a$250 deductible per injury per covered accident.Accidental Death&Dismemberment Class 1&Class 2 is$10,000 per person per accident. With regards to the Excess Accident Medical Coverage,Class 1 is all registered/approved participants and volunteers of the Participating Organization and its Chapters with respect to sonsored and approved activities including direct travel to and from the activity and home,not including overnight trips. With regards to the Excess Accident Medical Coverage,Class 2 is all registered/approved participants and volunteers of the Participating Organization and its Chapters with respect to sponsored and approved overnight trips including direct travel to and from the activity and home. CERTIFICATE HOLDER CANCELLATION ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ATTN:TONYA WALTON BE CANCELLED BEFORE THE EXPIRATION DATE ORANGE COUNTY FINANCE AND ADMINISTRATIVE SERVICES THEREOF NOTICE WILL BE DELIVERED IN 200 SOUTH CAMERON STREET ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 8181 HILLSBOROUGH,NC 27278 AUTHORIZED REPRESENTATIVE