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HomeMy WebLinkAbout2014-402 Finance - Bridge II Sports - Outside Agency Performance Agreement $2,500 aol M Dcl� FoanCL 2014-15 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2014,("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough,North Carolina, 27278, ("County")and Bridge II Sports, a not-for-profit corporation, located at 4122 Bennett Memorial Road Suite 105,Durham,NC 27705 ("Provider"). WITNESSETH. WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need,as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and Bridge II Sports agree as follows. 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2014 to June 30,2015 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application Scope of Services and any amendments or revision thereto which is attached as Exhibit"A" and incorporated by reference,to the residents of Orange County The Scope of Services may be different from the original application based on County appropriation, however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Program Budget, the maximum sum of$2,500 b All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider If the funds are expended not in accordance with the Scope of Services,at the discretion of the County the Provider may be required to repay the funds to the County c. The Provider shall be paid in four equal installments in the amount of$ 625 The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. DL� GC� Od � JUL 2 9 2014 By (Bridge H Sports) Orange County Outside Agency Performance Agreement Page 1 of 7 d. The County's obligation to make the three quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on 2014-15 performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 — December 31, January 1 — March 31 and April 1 - June 30 Reports are due on January 9,April 15,and July 10 of the program fiscal year b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services,upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default"), the County may immediately terminate this Agreement, in whole or in part, and from time to time.Notice of termination must be in writing, state the reason or reasons for the termination,and specify the effective date of the termination. i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement;or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered,or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv Nonperformance, incomplete service or performance,or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement,as determined by the County in its sole discretion. v Failure to adhere to the terms of applicable county,state or federal laws, regulations,or stated public policy b. In the event of default by the Provider,the county may elect to terminate this Agreement,in whole or in part and/or require the Provider to repay the funds within ten(10)business days from written notice of default. The County may (but shall not be required to) grant the (Bridge H Sports) Orange County Outside Agency Performance Agreement Page 2 of 7 Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain,during the period of performance of this Agreement,insurance: i. Worker's Compensation. For protection from claims under workers'or workmen's compensation acts, ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury,including bodily injury,sickness,disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance,including hired and non-owned vehicles, if any,covering personal injury or death,and property damage;and iv Professional Liability Insurance,covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents,consultants and employees. b Limits of Coverage- Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A- Statutory State NC&Coverage B-Employers Liability $500,000 each accident,disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate (Bridge II Sports) Orange County Outside Agency Performance Agreement Page 3 of 7 c. All insurance policies(with the exception of Worker's Compensation and Professional Liability)required under this Agreement shall name the County as an additional insured party and as a certificate holder Evidence of such insurance and all correspondence shall be sent to Orange County Risk Manager Post Office Box 8181 Hillsborough,NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9 Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense(including reasonable attorney's fees) ansing from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves,their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color,gender,national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided, this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner (Bridge II Sports) Orange County Outside Agency Per Agreement Page 4 of 7 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $12.76 per hour. To the extent possible, Orange County recommends that Bridge II Sports provide a living wage to its employees 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall. be in writing and mailed to the party addressed as follows County Finance&Administrative Services Provider Bridge II Sports Orange County 4122 Bennett Memorial Road Post Office Box 8181 Suite 105 Hillsborough,NC 27278 Durham,NC 27705 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings, written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider 17. Severability. All clauses found herein shall act independently of each other If a clause is found to be illegal or unenforceable,it shall have no effect on the other provisions of this Agreement It is understood by the parties hereto that if any part,term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part,term or provision held to be invalid 18 Governing Law. The laws of the State of North Carolina shall govern all aspects of this Agreement In the event that it is necessary for either party to initiate legal action regarding this Agreement, venue shall lie in Orange County, North Carolina The parties hereby waive their right to trial by jury in any action,proceeding or claim,arising out of this Agreement,which may be brought by either of the parties [SIGNATURES ON FOLLOWING PAGE] (Bridge H Sports) Orange County Outside Agency Performance Agreement Page 5 o,f 7 IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement,effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below For and on behalf of the Provider -A &MY\0( J 1 � 15� I�- Signature Date AC5)8\ ekA 7fla ww� Printed Name For and i behalf of Orange County Government Bonnie Hammersley,County M#ager Date Appr v d as rm and legal sufficiency 30 19- Offic of the ounty Att mey Dat Approved as to technical content This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act 49, A--- � OV/ Y Clarence Grier,Assistant County Manager/ ate Chief Financial Officer (Bridge H Sports) Orange County Outside Agency Performance Agreement Page 6 of 7 ATTACHMENT"A" Orange County Certifications—FY 2014-15 Outside Agency Performance Agreement Chief Contact,Administrators,Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact,administrators,chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name,title,residential address;phone and email address and if possible,fax number Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur The list should be in writing,with the name, physical address,mailing address and if possible,phone,fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County,and that any substantive changes made to this budget have been in advance authorized in writing by Orange County Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a separate sheet of paper Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County Certified by- Title: Date: 15 ( rovider' Signature) (Bridge H Sports) Orange County Outside Agency Performance agreement Page 7 of 7 EXHIBIT"A" Scope of Services-FY 2014- 15 Outside Agency Performance Agreement Agency Name: Bridge It Sports Program Name: Adapted Sports For Persons With Physical Disabilites Funding Award: $2,500 Outline how the agency will spend Orange County's funding award Expense Description Amount Portion of Recration Therapist Staff Sal 268 hours of adapted sports programs) $2,500 Program Services For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the contract and reporting memorandum Outline the mayor activities the agency will employ to attain the Anticipated Outcomes below,by June 30,2015 • Bridge II Sports will provide Orange County residents adapted sports opportunties in the areas of wheelchair basketball,cycling,track and field • Bridge II Sports will provide the adapted equipment and expert Program administer, weekly reminders to participants • Bridge II Sports will provide volunteer support. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure's description or for an earlier performance measure Performance Measures Anticipated Results Athletes will identify one skill goal to be achieved 80 Athlete will identify one academic goal to be achieved 80 Athlete will identify one personal independence goal to be achieved over season 80 Understanding of other disabilites on the team 80 Survey will be implemented at beginnm and end of sport season 80 Certified b Title Ci• Date- -7 (Provide ignature) AXIS 8000(08/10) CERTIFICATE OF INSURANCE 07/07/2014 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 142 North Main Street BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND Roanoke,Indiana 46783 THE CERTIFICATE HOLDER INSURED INSURERS AFFORDING COVERAGE Disabled Sports USA,Inc. BRIDGE II SPORTS INS A. AXIS Insurance Company 451 Hungerford Drive,Suite 100 INS B• Rockville,MD 20850 INS C CERT NUMBER. 1001170769 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 3,000,000 GL AXGL05101976-13 12/01/2013 12/01/2014 Prod ucts-Com feted Operations Aggregate 3,000,000 A Personal and Advertising Inaury 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 300,000 Medical Expense Limit(Any One Person Excluded Each Occurrence 5,000,000 XS AXXS05100447 13 12/01/2013 12/01/2014 General Aggregate-Per Chapter 5,000,000 A 12:01 a.m. 12:01 a.m. I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The Certificateholder is only an additional insured with respect to liability caused by the negligence of the Named Insured as per Form AXIS 1003-Additional Insured-Certifcateholders, but only with respect to the WHEELCHAIR BASKETBALL YOUTH AND ADULT from July 07 2014 through November 30,2014. Coverage available under policy#SRPO-50219-203 is on file with the policyholder Excess Accident Medical for Class 1&Class 2 is$25,000 with a$250 deductible per injury per covered accident.Accidental Death&Dismemberment Class 1&Class 2 is$10,000 per person per accident. With regards to the Excess Accident Medical Coverage,Class 1 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 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 ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ATTN:TONYA WALTON BE CANCELLED BEFORE THE EXPIRATION DATE ORANGE COUNTY FINANCE AND ADMINISTRATIVE SERVICES THEREOF NOTICE WILL BE DELIVERED IN 200 SOUTH CAMERON STREET ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 8181 HILLSBOROUGH,NC 27278 AUTHORIZED REPRESENTATIVE POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Coverage for acts of terrorism is included in your policy You are hereby notified that an "act of terrorism", as defined in Section 102(1)of the Terrorism Risk Insurance Act,as amended(the"Act"),means any act that is certified by the Secretary of the Treasury—in concurrence with the Secretary of State, and the Attorney General of the United States—to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission,and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Under your coverage, any losses resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula established by the Terrorism Risk Insurance Act, as amended. However, your policy may contain other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States Government generally reimburses 85%of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. The Terrorism Risk Insurance Act, as amended, contains a$100 billion cap that limits U S Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds$100 billion in any one calendar year If the aggregate insured losses for all insurers exceed $100 billion,your coverage may be reduced. The portion of your annual premium that is attributable to coverage for acts of terrorism is INCLUDED and does not include any charges for the portion of losses covered by the United States government under the Act. NOTICE TO BROKER MANDATORY POLICYHOLDER DISCLOSURE RE. TERRORISM INSURANCE COVERAGE We are required by the Terrorism Risk Insurance Act, as amended (the "Act"), to provide policyholders with clear and conspicuous disclosures. This notice must be provided at the time of offer,purchase and renewal of the policy We have provided you with a notice that meets the Act's requirements. You are instructed to deliver a copy of this notice to our insured. Includes copyrighted material 2007 National Association of Insurance Commissioners PURCH DISCL IL N 167 01 13 MARYLAND FRAUD STATEMENT Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison I IL N 167 01 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 IL P 001 01 04 U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy You should read your policy and review your Declarations page for complete information on the coverages you are provided This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC Please read this Notice carefully The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of"national emergency" OFAC has identified and listed numerous. • Foreign agents, • Front organizations, • Terrorists, • Terrorist organizations, and • Narcotics traffickers, as "Specially Designated Nationals and Blocked Persons" This list can be located on the United States Treas- ury's web site—http//www treas gov/ofac. In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U S sanctions law or is a Specially Designated National and Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC Other limitations on the premiums and payments also apply IL P 001 01 04 ©ISO Properties, Inc., 2004 Page 1 of 1 AXI !j COMMERCIAL EXCESS LIABILITY DECLARATIONS Policy Number- AXXS05100447-13 Renewal of-AXXSO4100447-12 AXIS Insurance Company 303 West Madison, Suite 500, Chicago, IL 60606 (312)977-0700 NAMED INSURED AND MAILING ADDRESS AGENT NAME AND ADDRESS Disabled Sports USA, Inc. American Specialty Insurance& Risk Services, Inc. 451 Hungerford Drive, Suite 100 dba A.S I R.S I Insurance Agency,American Rockville, MD 20850 Specialty Insurance & Risk Services Agency, and A S Insurance & Risk Services Agency 142 N Main Street, P O Box 309 Roanoke, IN 46783-0309 AGENT NO AE101 POLICY PERIOD FROM 12/01/13 TO' 12/01/14 AT 12 01 A.M STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE. IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY,WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY Excess Policy-Limits Of Insurance Each Occurrence Limit $5,000,000 Aggregate Limit $5,000,000 Per Club Other $N/A Excess Policy-Premium Premium (including premium subject to audit) $ State Tax or Other(If applicable) $N/A Premium Shown is Payable At Inception $ Audit Period If Applicable) ❑ Annually ❑ Semi-Annually ❑-Quarterly I ❑ Month) Endorsements Attached To The Excess Policy See Listing of Forms and Endorsements Forming a Part of this Policy (AXIS 0002) Countersigned N-44V--, Date. October 30 2013 By' Authorized F epresentative THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION(S), TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART(S), COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS, IF ANY,COMPLETE THE ABOVE NUMBERED POLICY Issued by- CM October 30, 2013 XS DEC0001(01/09) Page 1 of 2 Schedule Of Controlling Underlying Insurance Company- The Hartford Policy Number- TBD Policy Period 12/01/13-12/01/14 Employer's Limit Of Insurance. Liability Bodily Injury By Accident Each Accident $500,000 Bodily Injury By Disease Policy Limit $500,000 Bodily Injury By Disease Each Employee $500,000 Type Of Coverage: ® Occurrence ❑ Claims-Made Company-AXIS Insurance Company Policy Number-AXGL05101976-13 Policy Period: 12/01/13-12/01/14 General Limit Of Insurance. Liability Each Occurrence $1,000,000 Personal And Advertising Injury $1,000,000 Any one person or organization Products-Completed Operations Aggregate $3,000,000 General Aggregate $3,000,000 Per Club Company AXIS Insurance Company Policy Number- Commercial Policy Period Automobile Limit Of Insurance: Liability Garage Aggregate Limit For Other Than Autos(if applicable) $N/A Each Accident $N/A XS DEC0001(01/09) Page 2 of 2 it IN WITNESS WHEREOF, the Company has caused the facsimile signatures of its President and secretary to be affixed hereto, and has caused this policy to be signed on the Declarations Page by an authorized representative of the Company AXIS Insurance Company Att-� IAZ�� Gregory W Springer Andrew Weissert President Secretary AXIS 0001(04/08) POLICY NUMBER. AXXS05100447-13 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY LISTING OF FORMS AND ENDORSEMENTS FORMING A PART OF THIS POLICY Number: Title. PU RCHDISCL Policyholder Disclosure- Notice of Terrorism Insurance Coverage IL N167(01/13) Maryland Fraud Statement IL P001(01/04) U S Treasury Department's Office of Foreign Assets Control("OFAC")Advisory Notice to Policyholders XS DEC0001(01/09) Commercial Excess Liability Declarations AX IS0001(04/08) Officer Signature Page AX IS0002(04/08) Listing of Forms and Endorsements Forming a Part of this Policy IL 0017(11/98) Common Policy Conditions IL 0985(01/08) Disclosure Pursuant to Terrorism Risk Insurance Act CX 0001(09/08) Commercial Excess Liability Coverage Form CX 0130(09/08) Maryland Changes CX 2101(09/08) Nuclear Energy Liability Exclusion Endorsement(Broad Form) CX 2130(09/08) Cap on Losses from Certified Acts of Terrorism AX IS2000(01/09) Aggregate Limit Per Club AX IS2004(01/09) Exclusion-Abuse or Molestation AX IS2009(01/09) Exclusion-Asbestos AX IS2010(01/09) Exclusion- Lead Policy Change 41 Exclude Child Recovery Expenses Policy Change 42 Exclude Crisis Emergency Response it AXIS 0002(04/08) Page 1 of 1 i IL 00 17 11 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation b. Give you reports on the conditions we find, 1 The first Named Insured shown in the Declara- and tions may cancel this policy by mailing or deliv- c. Recommend changes. ering to us advance written notice of cancella- 2. We are not obligated to make any inspections, tion surveys, reports or recommendations and any 2. We may cancel this policy by mailing or deliv- such actions we do undertake relate only to in- ering to the first Named Insured written notice surability and the premiums to be charged. We of cancellation at least: do not make safety inspections. We do not un- a. 10 days before the effective date of cancel- dertake to perform the duty of any person or lation if we cancel for nonpayment of pre- organization to provide for the health or safety mium, or of workers or the public.And we do not warrant that conditions. b. 30 days before the effective date of cancel- lation if we cancel for any other reason a. Are safe or healthful, or 3. We will mail or deliver our notice to the first b. Comply with laws, regulations, codes or Named Insured's last mailing address known to standards. us. 3. Paragraphs 1 and 2. of this condition apply not 4. Notice of cancellation will state the effective only to us, but also to any rating, advisory, rate date of cancellation. The policy period will end service or similar organization which makes in- on that date. surance inspections, surveys, reports or rec- ommendations. 6. If this policy is cancelled, we will send the first 4. Paragraph 2. of this condition does not apply to Named Insured any premium refund due If we cancel, the refund will be pro rata. If the first any inspections, surveys, reports or recom- Named Insured cancels, the refund may be mendations we may make relative to certifica- less than pro rata. The cancellation will be ef- tion, under state or municipal statutes, ordi- fective even if we have not made or offered a sell or l regulations, of boilers, pressure ves- refund. sets or elevators 6. If notice is mailed, proof of mailing will be suffi- E. Premiums cient proof of notice The first Named Insured shown in the Declara- B. Changes tions. This policy contains all the agreements between 1 Is responsible for the payment of all premiums, you and us concerning the insurance afforded. and The first Named Insured shown in the Declara- 2. Will be the payee for any return premiums we tions is authorized to make changes in the terms pay of this policy with our consent. This policy's terms F Transfer Of Your Rights And Duties Under This can be amended or waived only by endorsement Policy issued by us and made a part of this policy C Examination Of Your Books And Records Your rights and duties under this policy may not be transferred without our written consent except We may examine and audit your books and re- in the case of death of an individual named in- cords as they relate to this policy at any time dur- sured ing the policy period and up to three years after- If you die, your rights and duties will be transferred ward to your legal representative but only while acting D Inspections And Surveys within the scope of duties as your legal represen- t We have the right to tative Until your legal representative is appointed, anyone having proper temporary custody of your a. Make inspections and surveys at any time, property will have your rights and duties but only with respect to that property IL 00 17 11 98 Copyright, Insurance Services Office Inc., 1998 Page 1 of 1 ❑ POLICY NUMBER. AXXS05100447-13 IL 09 85 01 08 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium(Certified Acts) $Included This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Cover- age Form(s)and/or Policy(s) Additional information, if any, concerning the terrorism premium Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Disclosure Of Premium C Cap On Insurer Participation In Payment Of In accordance with the federal Terrorism Risk In- Terrorism Losses surance Act, we are required to provide you with a If aggregate insured losses attributable to terrorist notice disclosing the portion of your premium, if acts certified under the Terrorism Risk Insurance any, attributable to coverage for terrorist acts certi- Act exceed $100 billion in a Program Year (Janu- fied under the Terrorism Risk Insurance Act. The ary 1 through December 31) and we have met our portion of your premium attributable to such cov- insurer deductible under the Terrorism Risk Insur- erage is shown in the Schedule of this endorse- ance Act, we shall not be liable for the payment of ment or in the policy Declarations. any portion of the amount of such losses that ex- B. Disclosure Of Federal Participation In Payment ceeds $100 billion, and in such case insured Of Terrorism Losses losses up to that amount are subject to pro rata al- location in accordance with procedures estab- The United States Government, Department of the lished by the Secretary of the Treasury Treasury, will pay a share of terrorism losses in- sured under the federal program. The federal share equals 85% of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 bil- lion in a Program Year (January 1 through De- cember 31), the Treasury shall not make any payment for any portion of the amount of such losses that exceeds$100 billion IL 09 85 01 08 0 ISO Properties, Inc., 2007 Page 1 of 1 ❑ COMMERCIAL EXCESS LIABILITY CX 00 0109 08 COMMERCIAL EXCESS LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage When we have no duty to defend, we will have Read the entire policy carefully to determine rights, the right to defend, or to participate in the de- duties and what is and is not covered fense of, the insured against any other suit Throughout this policy the words "you" and "your" seeking damages for"injury or damage" refer to the Named Insured shown in the Declarations, However, we will have no duty to defend the and any other person or organization qualifying as a insured against any suit seeking damages for Named Insured under this policy The words "we", which insurance under this policy does not ap- "us" and "our" refer to the company providing this ply insurance The word "insured" means any person or At our discretion, we may investigate any organization qualifying as such under the "controlling "event"that may involve this insurance and set- underlying insurance" tle any resultant claim or suit, for which we Other words and phrases that appear in quotation have the duty to defend marks in this Coverage Part have special meaning But Refer to Section IV — Definitions Other words and phrases that are not defined under this Coverage Part (1) The amount we will pay for "ultimate net but defined in the "controlling underlying insurance" loss" is limited as described in Section II — will have the meaning described in the policy of"con- Limits Of Insurance, and trolling underlying insurance" (2) Our right and duty to defend ends when we The insurance provided under this Coverage Part will have used up the applicable limit of insur- follow the same provisions, exclusions and limitations ance in the payment of judgments or set- that are contained in the applicable"controlling under- tlements under this Coverage Part How- lying insurance", unless otherwise directed by this ever, if the policy of "controlling underlying insurance To the extent such provisions differ or insurance" specifies that limits are reduced conflict, the provisions of this Coverage Part will ap- by defense expenses, our right and duty to ply However, the coverage provided under this Cov- defend ends when we have used up the erage Part will not be broader than that provided by applicable limit of insurance in the payment the applicable"controlling underlying insurance" of defense expenses, judgments or settle- There may be more than one "controlling underlying ments under this Coverage Part insurance" listed in the Declarations and provisions in b This insurance applies to "injury or damage" those policies conflict, and which are not superseded that is subject to an applicable "retained limit" by the provisions of this Coverage Part In such a If any other limit, such as, a sublimit, is speci- case, the provisions, exclusions and limitations of the fied in the "controlling underlying insurance", "controlling underlying insurance" applicable to the this insurance does not apply to "injury or particular "event" for which a claim is made or suit is damage" arising out of that exposure unless brought will apply that limit is specified in the Declarations under SECTION I—COVERAGES the Schedule of "controlling underlying insur- ance" 1. Insuring Agreement c. If the "controlling underlying insurance" re- a We will pay on behalf of the insured the "ulti- quires, for a particular claim, that the "injury or mate net loss" in excess of the "retained limit" damage" occur during its policy period in order because of "injury or damage" to which insu- for that coverage to apply, then this insurance ance provided under this Coverage Part ap- will only apply to that "injury or damage" if it plies occurs during the policy period of this Cover- We will have the right and duty to defend the age Part If the "controlling underlying insur- insured against any suit seeking damages for ance" requires that the"event"causing the par- such "injury or damage" when the applicable ticular"injury or damage" takes place during its limits of"controlling underlying insurance" have policy period in order for that coverage to ap- been exhausted in accordance with the provi- ply, then this insurance will apply to the claim sions of such "controlling underlying insu- only if the "event" causing that "injury or dam- ance" age"takes place during the policy period of this Coverage Part CX 00 01 09 08 ©ISO Properties, Inc, 2007 Page 1 of 6 ❑ d Any additional insured under any policy of (b) Claim or suit by or on behalf of a gov- "controlling underlying insurance" will auto- ernmental authority for damages be- matically be an additional insured under this cause of testing for, monitoring, cleaning insurance If coverage provided to the addi- up, removing, containing, treating, de- tional insured is required by a contract or toxifying or neutralizing, or in any way agreement, the most we will pay on behalf of responding to, or assessing the effects the additional insured is the amount of insur- of, pollutants ance required by the contract, less any This exclusion does not apply to the extent that amounts payable by any"controlling underlying valid "controlling underlying insurance" for the insurance' pollution liability risks described above exists or Additional insured coverage provided by this would have existed but for the exhaustion of insurance will not be broader than coverage underlying limas for"injury or damage" provided by the "controlling underlying insur- d Workers'Compensation And Similar Laws ance" 2. Exclusions Any obligation of the insured under a workers' compensation, disability benefits or unem- The following exclusions, and any other exclusions ployment compensation law or any similar law added by endorsement, apply to this Coverage SECTION II—LIMITS OF INSURANCE Part In addition, the exclusions applicable to any "controlling underlying insurance" apply to this in- 1. The Limits of Insurance shown in the Declarations, surance unless superseded by the following ex- and the rules below fix the most we will pay re- clusions, or superseded by any other exclusions gardless of the number of added by endorsement to this Coverage Part a. Insureds, Insurance provided under this Coverage Part does b Claims made or suits brought, or number of not apply to vehicles involved, a Medical Payments c Persons or organizations making claims or Medical payments coverage or expenses that bringing suits, or are provided without regard to fault, whether or d Limits available under any "controlling underly- not provided by the applicable "controlling un- ing insurance" dedyfng insurance". 2 The Limits of Insurance of this Coverage Part will b Auto apply as follows Any loss, cost or expense payable under or re- a. This insurance only applies in excess of the sulting from any of the following auto cover- "retained limit" ages b The Aggregate Limit is the most we will pay for (1) First-party physical damage coverage, the sum of all "ultimate net loss", for all "injury (2) No-fault coverage, or damage"covered under this Coverage Part (3) Personal injury protection or auto medical However, this Aggregate Limit only applies to payments coverage; or "injury or damage" that is subject to an aggre- gate limit of insurance under the "controlling ( ) underlying insurance age c Pollution c Subject to Paragraph 2.b. above, the Each Occurrence Limit is the most we will pay for the (1) "Injury or damage" which would not have sum of all "ultimate net loss" under this insur- occurred, in whole or in part, but for the ac- ance because of all "injury or damage" arising tual, alleged or threatened discharge, dis- out of any one"event" persal, seepage, migration, release or es- d. if the Limits of Insurance of the "controlling cape of pollutants at any time underlying insurance" are reduced by defense (2) Any loss, cost or expense arising out of expenses by the terms of that policy, any pay- any ments for defense expenses we make will re- (a) Request, demand, order or statutory or duce our applicable Limits of Insurance in the regulatory requirement that any insured same manner or others test for, monitor, clean up, re- move, contain, treat, detoxify or neutral- ize, or in any way respond to, or assess the effects of, pollutants,or Page 2 of 5 ©ISO Properties, Inc, 2007 CX 00 0109 08 0 3. If any "controlling underlying insurance" has a 3. Duties In The Event Of An Event, Claim Or Suit policy period that is different from the policy period a. You must see to it that we are notified as soon of this Coverage Part then, for the purposes of this as practicable of an "event", regardless of the insurance, the "retained limit" will only be reduced amount, which may result in a claim under this or exhausted by payments made for "injury or insurance To the extent possible, notice damage"covered under this insurance should include The Aggregate Limit of this Coverage Part applies (1) How, when and where the "event" took separately to each consecutive annual period of this place, Coverage Part and to any remaining period of this Coverage Part of less than 12 months, starting with (2) The names and addresses of any injured the beginning of the policy period shown in the Decla- persons and witnesses, and rations, unless the policy period is extended after (3) The nature and location of any "injury or issuance for an additional period of less than 12 damage"arising out of the"event" months. In that case, the additional period will be b If a claim is made or suit is brought against any deemed part of the last preceding period for purposes insured, you must of determining the Limits of Insurance SECTION HI—CONDITIONS (1) Immediately retard the specifics of the claim or suit and the date received, and The following Conditions apply In addition, the Condi- (2) Notify us as soon as practicable bons applicable to any controlling underlying insur- ance" are also applicable to the coverage provided You must see to it that we receive written po- under this insurance unless superseded by the follow- tice of the claim or suit as soon as practicable ing conditions c You and any other insured involved must 1 Appeals (1) Immediately send us copies of any de- If the "controlling underlying insurer" or insured mands, notices, summonses or legal pa- elects not to appeal a judgment in excess of the pers received in connection with the claim amount of the"retained limit", we may do so at our or suit, own expense We will also pay for taxable court (2) Authonze us to obtain records and other costs, pre- and postludgment interest and dis- information, bursements associated with such appeal In no (3) Cooperate with us in the investigation or event will this provision increase our liability be- settlement of the claim or defense against yond the applicable Limits of Insurance described the suit, and in Section 11—Limits Of Insurance 2 Bankruptcy (4) Assist us, upon our request, in the en- forcement of any right against any person a. Bankruptcy Of Insured or organization which may be liable to the Bankruptcy or insolvency of the insured or of insured because of "injury or damage" to the insured's estate will not relieve us of our which this insurance may also apply obligations under this Coverage Part d No insured will, except at that insured's own b Bankruptcy Of Controlling Underlying cost, voluntarily make a payment, assume any Insurer obligation, or incur any expense, other than for Bankruptcy of the "controlling underlying in- first aid,without our consent surer" will not relieve us of our obligations un- 4 First Named Insured Duties der this Coverage Part The first Named Insured is the person or organiza- However, insurance provided under this Coverage tion first named in the Declarations and is respon- Part will not replace any "controlling underlying in- sible for the payment of all premiums The first surance" in the event of bankruptcy or insolvency Named Insured will act on behalf of all other of the "controlling underlying insurer" The inuur- Named Insureds for giving and receiving of notice ante provided under this Coverage Part will apply of cancellation or the receipt of any return Are- as if the "controlling underlying insurance"were in mium that may become payable full effect and recoverable CX 00 01 09 08 ©ISO Properties, Inc, 2007 Page 3 of 5 13 At our request, the first Named Insured will furnish Such exhaustion or reduction is not a failure to us, as soon as practicable, with a complete copy maintain "controlling underlying insurance" Failure of any "controlling underlying insurance" and any to maintain "controlling underlying insurance" will subsequently issued endorsements or policies not invalidate insurance provided under this Cov- which may in any way affect the insurance pro- erage Part, but insurance provided under this Cov- vided under this Coverage Part. erage Part will apply as if the "controlling underly- 5. Cancellation ing insurance"were in full effect. a. The first Named Insured shown in the Declara- The first Named Insured must notify us in writing, tions may cancel this policy by mailing or deliv- as soon as practicable, if any "controlling underly- ering to us advance written notice of cancella- ing insurance" is cancelled, not renewed, replaced tion or otherwise terminated, or if the limits or scope of coverage of any "controlling underlying insurance" b. We may cancel this policy by mailing or deliv- is changed ering to the first Named Insured written notice of cancellation at least: 8. Other Insurance (1) 10 days before the effective date of cancel- a. This insurance is excess over, and shall not lation if we cancel for nonpayment of pre- contribute with any of the other insurance, mium, or whether primary, excess, contingent or on any other basis This condition will not apply to in- (2) 30 days before the effective date of cancel- surance specifically written as excess over this lation if we cancel for any other reason. Coverage Part. c. We will mail or deliver our notice to the first When this insurance is excess, if no other in- Named Insured's last mailing address known to surer defends, we may undertake to do so, but us. we will be entitled to the insured's rights d. Notice of cancellation will state the effective against all those other insurers. date of cancellation. The policy period will end b. When this insurance is excess over other in- on that date surance, we will pay only our share of the "ul- e. If this policy is cancelled, we will send the first timate net loss"that exceeds the sum of- Named Insured any premium refund due. If we (1) The total amount that all such other insur- cancel, the refund will be pro rata. If the first ance would pay for the loss in the absence Named Insured cancels, the refund may be of the insurance provided under this Cover- less than pro rata. The cancellation will be ef- age Part; and fective even if we have not made or offered a refund (2) The total of all deductible and self-insured f If notice is mailed, proof of mailing will be suffi- amounts under all that other insurance 9 Premium Audit cient proof of notice 6. Changes a. We will compute all premiums for this Cover- age Part in accordance with our rules and This Coverage Part contains all the agreements rates. between you and us concerning the insurance af- forded. The first Named Insured is authorized by b. If this policy is auditable, the premium shown in all other insureds to make changes in the terms of this Coverage Part as advance premium is a this Coverage Part with our consent. This Cover- deposit premium only At the close of each au- age Part's terms can be amended or waived only dit period,we will compute the earned premium by endorsement. for that period and send notice to the first Named Insured The due date for audit pre- 7 Maintenance Of/Changes To Controlling mium is the date shown as the due date on the Underlying Insurance bill. If the sum of the advance and audit premi- Any "controlling underlying insurance" must be ums paid for the policy period is greater than maintained in full effect without reduction of cover- the earned premium, we will return the excess age or limits except for the reduction of aggregate to the first Named Insured. limits in accordance with the provisions of such c. The first Named Insured must keep records of "controlling underlying insurance" that results from the information we need for premium computa- "injury or damage"to which this insurance applies. tion, and send us copies at such times as we may request. Page 4 of 5 ©ISO Properties, Inc., 2007 CX 00 01 09 08 ❑ 10 Loss Payable We will cooperate in the transfer of control of Liability under this Coverage Part does not apply defense to any insurer specifically written as to a given claim unless and until: excess over this Coverage Part of any out- standing claims or suits seeking damages to a. The insured or insured's "controlling underlying which this insurance applies and which would insurer" has become obligated to pay the "re- have been covered by the "controlling underly- tained limit"; and ing insurance" had the applicable limit not been b. The obligation of the insured to pay the "ulti- exhausted. mate net loss" in excess of the "retained limit" In the event that there is no insurance written has been determined by a final settlement or as excess over this Coverage Part, we will co- judgment or written agreement among the in- operate in the transfer of control to the insured sured, claimant, "controlling underlying insurer" and its designated representative (or a representative of one or more of these) 13.When We Do Not Renew and us. 11 Legal Action Against Us If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured No person or organization has a right under this shown in the Declarations written notice of the Coverage Part: nonrenewal not less than 30 days before the expi- a. To join us as a party or otherwise bring us into ration date a suit asking for damages from an insured; or If notice is mailed, proof of mailing will be sufficient b. To sue us on this Coverage Part unless all of proof of notice. its terms have been fully complied with SECTION IV—DEFINITIONS A person or organization may sue us to recover on The definitions applicable to any "controlling underly- an agreed settlement or on a final judgment ing insurance" also apply to this insurance. In addi- against an insured, but we will not be liable for tion, the following Definitions apply damages that are not payable under the terms of this Coverage Part or that are in excess of the ap- 1 "Controlling underlying insurance" means any plicable limit of insurance An agreed settlement policy of insurance or self-insurance listed in the means a settlement and release of liability signed Declarations under the Schedule of "controlling by us, the insured, "controlling underlying insurer" underlying insurance" and the claimant or the claimant's legal represen- 2. "Controlling underlying insurer" means any insurer tative. who provides any policy of insurance listed in the 12.Transfer Of Defense Declarations under the Schedule of "controlling underlying insurance a. Defense Transferred To Us 3. "Event" means an "occurrence", offense, accident, When the limits of "controlling underlying in- act, or other event, to which the applicable "con- surance" have been exhausted, in accordance trolling underlying insurance"applies. with the provisions of"controlling underlying in- surance , we may elect to have the defense 4. "Injury or damage" means any injury or damage, transferred to us. We will cooperate in the covered in the applicable "controlling underlying transfer of control to us of any outstanding insurance"arising from an"event" claims or suits seeking damages to which this 5. "Retained limit" means the available limits of"con- insurance applies and which would have been trolling underlying insurance" applicable to the covered by the "controlling underlying insur- claim ance" had the applicable limit not been ex- 6. "Ultimate net loss" means the total sum, after hausted reduction for recoveries, or salvages collectible, b. Defense Transferred By Us that the insured becomes legally obligated to pay When our limits of insurance have been ex- as damages by reason of- hausted our duty to provide a defense will a. Settlements,judgments, binding arbitration, or cease. b. Other binding alternate dispute resolution pro- ceeding entered into with our consent. "Ultimate net loss" includes defense expenses if the "controlling underlying insurance" specifies that limits are reduced by defense expenses. CX 00 01 09 08 ©ISO Properties, Inc., 2007 Page 5 of 5 ❑ COMMERCIAL EXCESS LIABILITY CX 01 30 09 08 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY MARYLAND CHANGES This endorsement modifies insurance provided under the following. COMMERCIAL EXCESS LIABILITY COVERAGE PART Paragraph 9 b. of the Premium Audit provision of Section III—Conditions is replaced by the following, b. If this policy is auditable, the premium shown in this Coverage Part as advance premium is a deposit premium only At the close of each au- dit period we will compute the earned premium for that period and send notice to the first Named Insured The due date for audit and ret- rospective premiums is 30 days from the date of the bill If the sum of the advance and audit premiums paid for the policy is greater than the earned premium, we will return the excess to the first Named Insured. CX 01 30 09 08 © ISO Properties, Inc., 2007 Page 1 of 1 ❑ COMMERCIAL EXCESS LIABILITY CX 21 01 09 08 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2., (3) The "injury or damage" arises out of the Exclusions furnishing by an insured of services, mate- 2. Exclusions rials, parts or equipment in connection with NUCLEAR ENERGY LIABILITY the planning, construction, maintenance, operation or use of any"nuclear facility", but a. Under any Liability Coverage, to "injury or if such facility is located within the United damage", States of America, its territories or posses- (1) With respect to which an insured under the sions or Canada, this Exclusion (3) applies policy is also an insured under a nuclear only to property damage to such "nuclear energy liability policy issued by Nuclear En- facility and any property thereat. ergy Liability Insurance Association, Mutual c. As used in this endorsement: Atomic Energy Liability Underwriters, Nu- "Hazardous properties" includes radioactive, clear Insurance Association of Canada or toxic or explosive properties. any of their successors, or would be an in- sured under any such policy but for its ter- "Nuclear material" means "source material", " mination upon exhaustion of its limit of li- special nuclear material" or "by-product mate- ability; or rial" (2) Resulting from the "hazardous properties" "Source material", "special nuclear material", of "nuclear material" and with respect to and "by-product material" have the meanings which (a) any person or organization is re- given them in the Atomic Energy Act of 1954 or quired to maintain financial protection pur- in any law amendatory thereof suant to the Atomic Energy Act of 1954, or "Spent fuel" means any fuel element or fuel any law amendatory thereof, or (b) the in- component, solid or liquid, which has been sured is, or had this policy not been issued used or exposed to radiation in a"nuclear reac- would be, entitled to indemnity from the tor" United States of America, or any agency "Waste" means any waste material (a) contain- thereof, under any agreement entered into ing "by-product material" other than the tailings by the United States of America, or any or wastes produced by the extraction or con- agency thereof, with any person or organi- centration of uranium or thorium from any ore zation processed primarily for its "source material" b. Under any Liability Coverage, to "injury or content, and (b) resulting from the operation by damage" resulting from "hazardous properties" any person or organization of any "nuclear fa- of"nuclear material", if- cility" included under the first two paragraphs of (1) The "nuclear material" (a) is at any"nuclear the definition of"nuclear facility" facility" owned by, or operated by or on be- "Nuclear facility" means. half of, an insured or (b) has been dis- (a) Any"nuclear reactor", charged or dispersed therefrom, (2) The "nuclear material" is contained in (b) Any equipment or device designed or "spent fuel" or "waste" at any time pos- used for (1) separating the isotopes of uranium or plutonium, (2) processing or sessed, handled, used, processed, stored, utilizing "spent fuel", or (3) handling, transported or disposed of, by or on behalf processing or packaging "waste'; of an insured; or CX 21 0109 08 0 ISO Properties, Inc. 2007 Page 1 of 2 ❑ (c) Any equipment or device used for the processing, fabricating or alloying of "special nuclear material" if at any time the total amount of such material in the custody of the "insured" at the premises where such equipment or device is lo- cated consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235, (d) Any structure, basin, excavation, prem- ises or place prepared or used for the storage or disposal of"waste", and includes the site on which any of the fore- going is located, all operations conducted on such site and all premises used for such opera- tions. "Nuclear reactor' means any apparatus de- signed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material "Injury or damage" includes all forms of radio- active contamination of property Page 2 of 2 ©ISO Properties, Inc., 2007 CX 21 01 09 08 ❑ COMMERCIAL EXCESS LIABILITY CX 21 30 09 08 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE PART Any endorsement addressing acts of terrorism (how- "Certified act of terrorism" means an act that is certi- ever defined) in any "controlling underlying insurance" fied by the Secretary of the Treasury, in concurrence does not apply to this excess insurance The following with the Secretary of State and the Attorney General provisions addressing acts of terrorism apply with of the United States, to be an act of terrorism pursu- respect to this excess insurance ant to the federal Terrorism Risk Insurance Act. The If aggregate insured losses attributable to terrorist criteria contained in the Terrorism Risk Insurance Act acts certified under the federal Terrorism Risk Insur- for a"certified act of terrorism" include the following ance Act exceed $100 billion in a Program Year 1 The act resulted in insured losses in excess of$5 (January 1 through December 31) and we have met million in the aggregate, attributable to all types of our insurer deductible under the Terrorism Risk Insur- insurance subject to the Terrorism Risk Insurance ance Act, we shall not be liable for the payment of any Act; and portion of the amount of such losses that exceeds 2. The act is a violent act or an act that is dangerous $100 billion, and in such case insured losses up to to human life, property or infrastructure and is that amount are subject to pro rata allocation in ac- committed by an individual or individuals as part of cordance with procedures established by the Secre- an effort to coerce the civilian population of the tary of the Treasury United States or to influence the policy or affect the conduct of the United States Government by coercion CX 21 30 09 08 0 Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY AGGREGATE LIMIT PER CLUB This endorsement modifies insurance provided under the following COMMERCIAL EXCESS LIABILITY COVERAGE PART The Aggregate Limit shown under SECTION II — LIMITS OF INSURANCE applies separately to each club insured under this policy All other terms and conditions remain unchanged AXIS 2000 (01/09) Includes copyrighted material of the Insurance Services Page 1 of 1 Office, Inc. used with its permission THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY EXCLUSION - ABUSE OR MOLESTATION This endorsement modifies insurance provided under the following COMMERCIAL EXCESS LIABILITY COVERAGE PART The following is added to Paragraph 2. Exclusions of SECTION I—COVERAGES The insurance provided under this coverage part does not apply to 1 The actual or threatened abuse or molestation by anyone of any person while in the care, custody or control of any insured, or 2. The negligent: a. Employment; b. Investigation, c. Supervision, d. Reporting to the proper authorities, or failure to so report; or e. Retention, of a person for whom any insured is or ever was legally responsible and whose conduct would be excluded by Paragraph 1 above. All other terms and conditions remain unchanged. AXIS 2004 (01/09) Includes copyrighted material of the Insurance Services Page 1 of 1 Office, Inc. used with its permission. THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY EXCLUSION - ASBESTOS This endorsement modifies insurance provided under the following COMMERCIAL EXCESS LIABILITY COVERAGE PART The following is added to Paragraph 2. Exclusions of SECTION I—COVERAGES, This insurance does not apply to Asbestos "Injury or damage" arising directly or indirectly, out of* a. The actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of asbestos, asbestos fibers whether the asbestos is in pure form or is or was combined with any other products or material, or any other form of asbestos, or products or materials containing asbestos, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to any injury or damage, b Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediation or disposing of, or in any way responding to, or assessing the effects of asbestos, asbestos fibers, or any other form of asbestos, by any insured or by any other person or entity; c. Any supervision, instructions, recommendations, warnings, or advice given or which should have been given in connection with a. and b above, d Any obligation to share damages with or repay someone else who must pay damages because of asbestos or products or materials containing asbestos, or e Any injury or damage caused or alleged to have been caused by the removal, eradication, detoxification, remediation or decontamination of asbestos or property containing asbestos This exclusion shall apply without regard to the source or sources of asbestos, or the basis of the insured's liability This exclusion includes defects or negligence in design, construction or materials, or any other event, conduct or misconduct, which may have or is claimed to have precipitated, caused or acted jointly, concurrently, or in any sequence with asbestos in causing injury or damage All other terms and conditions remain unchanged AXIS 2009 (01/09) Includes copyrighted material of the Insurance Services Page 1 of 1 Office, Inc. used with its permission THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY EXCLUSION - LEAD This endorsement modifies insurance provided under the following COMMERCIAL EXCESS LIABILITY COVERAGE PART The following is added to Paragraph 2. Exclusions of SECTION I—COVERAGES This insurance does not apply to Lead "Injury or damage"arising out of or caused by* a. The actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of lead, whether the lead is in pure form or is or was combined with any other product or material or products or materials containing lead regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to any injury or damage, b Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediation or disposing of, or in any way responding to, or assessing the effects of lead by any insured or by any other person or entity; c. Any supervision, instructions, recommendations, warnings, or advice given or which should have been given in connection with a. and b above, d Any obligation to share damages with or repay someone else who must pay damages because of lead or products or materials containing lead, or e Any injury or damage caused or alleged to have been caused by the removal, eradication, detoxification, remediation or decontamination of lead or property containing lead This exclusion shall apply without regard to the source or sources of lead, or the basis of the insured's liability This exclusion includes defects or negligence in design, construction or materials, or any other event, conduct or misconduct, which may have or is claimed to have precipitated, caused or acted jointly, concurrently, or in any sequence with lead in causing injury or damage All other terms and conditions remain unchanged AXIS 2010 (01/09) Includes copyrighted material of the Insurance Services Page 1 of 1 Office, Inc. used with its permission. POLICY NUMBER.AXXS05100447-13 COMMERCIAL LIABILITY UMBRELLA CU 22 40 12 04 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY POLICY CHANGES This endorsement modifies insurance provided under the following COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL EXCESS LIABILITY COVERAGE PART Effective Date of Change 12/01/13 Change Endorsement No 01 Named Insured- Disabled Sports USA, Inc. The following item(s) ❑ Insured's Name ❑ Insured's Mailing Address ❑ Policy Number ❑ Company ❑ Effective/Expiration Date ❑ Insured's Legal Status/Business of Insured ❑ Payment Plan ❑ Premium Determination ❑ Additional Interested Parties: ❑ Coverage Forms and Endorsements X❑ Limits/Exposures ❑ Self-Insured Retention ❑ Covered Property/Located Description ❑ Classification/Class Codes ❑ Rates ❑ Underlying Insurance is (are) changed to read{See Additional Page(s)) The above amendments result in a change in the premium as follows. X] NO CHANGES ❑ TO BE ADJUSTED ADDITIONAL PREMIUM RETURN PREMIUM AT AUDIT $ $ Endorsement Effective see above Countersigned By- Named Insured: see above Authorized Representative), CU 22 40 12 04 ©ISO Properties, Inc., 2004 Page 1 of 2 ❑ POLICY CHANGES ENDORSEMENT DESCRIPTION As of the effective date hereof, it is hereby understood and agreed that, in the event that a minor child is abducted from your premises during your insured business operations, this insurance does not apply to any of the following: a. Fees charged by an investigative services company that assists in the recovery of the abducted minor child, b Rewards leading to the recovery of the abducted minor child, c. Expenses associated with psychiatric and/or psychological counseling for the immediate family and for the abducted minor child once the minor child is recovered; and d. Necessary medical, surgical, hospital and nursing expenses required for the abducted minor child once the minor child is recovered. All other terms and conditions remain unchanged. Issued by- CM October 30, 2013 Page 2 of 2 ©ISO Properties, Inc., 2004 CU 22 40 12 04 ❑ POLICY NUMBER.AXXS05100447-13 COMMERCIAL LIABILITY UMBRELLA CU 22 40 12 04 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY POLICY CHANGES This endorsement modifies insurance provided under the following COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL EXCESS LIABILITY COVERAGE PART Effective Date of Change 12/01/13 Change Endorsement No 02 Named Insured Disabled Sports USA, Inc. The following item(s) ❑ Insured's Name ❑ Insured's Mailing Address ❑ Policy Number ❑ Company ❑ Effective/Expiration Date ❑ Insured's Legal Status/Business of Insured ❑ Payment Plan ❑ Premium Determination ❑ Additional Interested Parties. ❑ Coverage Forms and Endorsements Limits/Exposures ❑ Self-Insured Retention ❑ Covered Property/Located Description ❑ Classification/Class Codes ❑ Rates ❑ Underlying Insurance is(are) changed to read (See Additional Page(s)) The above amendments result in a change in the premium as follows NO CHANGES ❑ TO BE ADJUSTED ADDITIONAL PREMIUM RETURN PREMIUM AT AUDIT $ $ Endorsement Effective see above Countersigned By- Named Insured see above Authorized Representative) CU 22 40 12 04 C ISO Properties, Inc., 2004 Page 1 of 2 ❑ POLICY CHANGES ENDORSEMENT DESCRIPTION As of the effective date hereof, it is hereby understood and agreed that this insurance does not apply to any "Crisis Management Emergency Response Expenses" as defined in the underlying Commercial General Liability policy All other terms and conditions remain unchanged. Issued by, CM October 30, 2013 Page 2 of 2 ©ISO Properties, Inc., 2004 CU 22 40 12 04 ❑ THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY POLICY CHANGES Policy Change Number 08 POLICY NUMBER POLICY CHANGES COMPANY AXGL05101976-13 EFFECTIVE AXIS Insurance Company 12/26/13 NAMED INSURED AUTHORIZED REPRESENTATIVE Disabled Sports USA, Inc. American Specialty Insurance& Risk Services, Inc. dba A.S I R.S I Insurance Agency,American Specialty Insurance& Risk Services Agency, and A S Insurance& Risk Services Agency COVERAGE PARTS AFFECTED Commercial General Liability CHANGES As of the effective date hereof, it is hereby understood and agreed that Form AXIS 1104 SEXUAL ABUSE OR MOLESTATION COVERAGE, Limits of Insurance is amended to read as follows, but only with respects to the Bridge II Sports Chapter Each Occurrence. $1,000,000 Aggregate $1,000,000 Additional premium due $50 All other terms and conditions remain unchanged Issued by- KS February 11, 2014 Authorized R tpresentative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 Copyright, ISO Commercial Risk Services, Inc., 1983