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DocuSign Envelope ID:88377437-EE99-4E08-B6B1-CD4F113C0672 <br /> AGENCY CUSTOMER ID: <br /> LOC#: <br /> A 0 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> American Specialty Insurance&Risk Services, Inc. Disabled Sports USA, Inc. <br /> POLICY NUMBER Bridge II Sports <br /> ASG089703602 451 Hungerford Drive,Suite 100 <br /> CARRIER NAIC CODE Rockville, MD 20850 <br /> Greenwich Insurance Company 22322 EFFECTIVE DATE: 12/01/2016 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE-Certificate#1001354674 <br /> -With regards to the Excess Accident Medical Coverage,Class 1 &3 is all registered/approved participants and volunteers of the Participating Organization <br /> and its Chapters with respect to sponsored and approved activities including direct travel to and from the activity and home, not including overnight trips. <br /> -With regards to the Excess Accident Medical Coverage,Class 2&4 is all registered/approved participants and volunteers of the Participating Organization <br /> and its Chapters with respect to sponsored and approved overnight trips including direct travel to and from the activity and home. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />