2016-579-E Finance - Bridge II Sports - Outside Agency Performance Agreement

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_DocuSign Envelope ID: 1007B77C-A009-4AA3-964B-3B03B9585341 CERTIFICATE OF INSURANCE 12/28/2015 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: 1001273598 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 Club 5,000,000 GL ASG089703601 12/01/2015 12/01/2016 Products-Completed Operations Aggregate 5,000,000 A Personal and Advertising Injury 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-Each Occurrence 1,000,000 Abuse-Molestation-Aggregate 1,000,000 Each Occurrence 5,000,000 XS ASX089704001 12/01/2015 12/01/2016 Products-Completed Operations Aggregate 5,000,000 A General Aggregate-Per Club 5,000,000 12:01 a.m. 12:01 a.m. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - Evidence of coverage as respects to the BRIDGE II SPORTS. - 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. CERTIFICATE HOLDER CANCELLATION DISABLED SPORTS USA, I NC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BRIDGE I I SPORTS BE CANCELLED BEFORE THE EXPIRATION DATE 4122 BENNETT MEMORIAL RD THEREOF,NOTICE WILL BE DELIVERED IN SUITE 105 AND 109 ACCORDANCE WITH THE POLICY PROVISIONS. DURHAM,NC 27705 AUTHORIZED REPRESENTATIVE