2015-507-E Finance - Bridge II Sports - 2015-16 Outside Agency Performance Agreement

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DocuSign Envelope ID:8A53AD8F-2163-47C6-8232-15DOF9057761 CERTIFICATE OF INSURANCE 08/27/2015 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 7609 W.Jefferson Boulevard,Suite 100 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND Fort Wayne, Indiana 46804 THE CERTIFICATE HOLDER. INSURED INSURERS AFFORDING COVERAGE Disabled Sports USA, Inc. INS.A: Greenwich Insurance Company 451 Hungerford Drive,Suite 100 INS. B: Rockville,MD 20850 INS. C: BRIDGE II SPORTS CERT NUMBER: 1001252130 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 5,000,000 GL ASG0897036 12/01/2014 12/01/2015 Products-Completed Operations Aggregate 5,000,000 A Personal and Advertising In'ury 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 1,000,000 Medical Expense Limit(Any One Person Excluded Abuse-Molestation 1,000,000 Each Occurrence 5,000,000 XS ASX0897040 12/01/2014 12/01/2015 Prod ucts-Com p Ieted Operations Aggregate 5,000,000 A 12:01 a.m. 12:01 a.m. General Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - Coverage available under policy#SRPO-50219-203 is on file with the policyholder.Excess Accident Medical for Class 1&2-$25,000 with a$250 deductible per injury per covered accident.Accidental Death&Dismemberment is$10,000 per person per accident.Class 3&4-$100,000 with a$250 deductible per injury per covered accident.Accidental Death& Dismemberment is$10,000 per person per accident. With regards to the Excess Accident Medical Coverage,Class 1&3 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&4 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. - The Certificate holder is only an additional insured with respect to liability caused by the negligence of the Named Insured as per Form GXA 1-428-Additional Insured-Certificateholder, but only with respect to ADAPTED SPORTS FOR INDIVIDUALS LIVING IN ORANGE COUNTY from August 27,2015 through November 30,2015. CERTIFICATE HOLDER CANCELLATION ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES POST OFFICE BOX 8181 BE CANCELLED BEFORE THE EXPIRATION DATE HILLSBOROUGH, NC 27278 THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE p✓l"