2017-485-E Finance - Bridge II Sports - Outside Agency Performance Agreement

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DocuSign Envelope ID:88377437-EE99-4E08-B6B1-CD4F113C0672 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/25/2016 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: American Specialty Insurance&Risk Services, Inc. (a//c,Nr o,Ext): 260-969-5203 AAA/c,No): 260-969-4729 E-MAIL ADDRESS: 7609 W.Jefferson Blvd.,Suite 100 INSURER(S)AFFORDINGCOVERAGE NAIC# Fort Wayne IN 46804 INSURERA: Greenwich Insurance Company 22322 INSURED INSURER B: Disabled Sports USA, Inc. INSURER C: Bridge II Sports INSURERD: 451 Hungerford Drive,Suite 100 INSURERE: Rockville MD 20850 INSURER F: COVERAGES CERTIFICATE NUMBER: 1001354674 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTE CLAIMS-MADE X OCCUR PREMISES O(Ea occur ence) $ 1,000,000 MED EXP(Any one person) $ Excluded A N ASG089703602 12/01/2016 12/01/2017 PERSONAL&ADVINJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 5,000,000 X OTHER: CLUB $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE N N ASX089704002 12/01/2016 12/01/2017 AGGREGATE $ 5,000,000 DED RETENTION$ PROD-COMP WK HAZ AGG $ 5,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) -Evidence of coverage as respects to 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. CERTIFICATE HOLDER CANCELLATION DISABLED SPORTS USA, INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BRIDGE II SPORTS AUTHORIZED REPRESENTATIVE 3729 MURPHEY SCHOOL ROAD Durham NC 27705 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD