2018-473-E Finance - Bridge II Sports outside agency agreement

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DocuSign Envelope ID: E30588DE -A1 BC- 443D- A5C4- 3BE790331500 ASR °� CERTIFICATE OF LIABILITY INSURANCE FDATE (MMIDDIYYYY) 08/13/2018 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. HONE Ext : 260- 969 -5203 FA No): 260 - 969 -4729 E -MAIL COMMERCIAL GENERAL LIABILITY ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 7609 W. Jefferson Blvd., Suite 100 INSURERA: Arch Insurance Company 11150 Fort Wayne IN 46804 INSURED INSURER B : INSURER C, Disabled Sports USA, Inc. INSURER D: PREM SES (Ea olccur ence ) 451 Hungerford Drive, Suite 608 INSURER E : MED EXP (Any one person) $ Excluded INSURER F: Rockville MD 20850 COVERAGES CERTIFICATE NUMBER: 1001595594 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICYNUMBER POLICY EFF MM /DDIYYYY POLICY EXP MM /DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR PREM SES (Ea olccur ence ) $ 1,000,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 A Y SBCGL0408100 12/01/2017 12/01/2018 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY ❑ PRO- JECT [::] LOC PRODUCTS - COMP /OP AGG $ 5,000,000 X $ OTHER: CLUB AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE SBFXS0054000 12/01/2017 12/01/2018 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANYPROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ 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 I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage applies to the following chapter: BRIDGE II SPORTS, . The General Liability policy includes Form CG 2133 Exclusion - Designated Products with the following products excluded: Athletic or exercise equipment when manufactured by you or manufactured by others to your specifications. CERTIFICATE HOLDER CANCELLATION Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron St, PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD