PREPARED BY: 2560 RIVER PARK PLAZA, SUITE 300 FORT WORTH, TEXAS (866) PULLENINS.COM

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1 WYOMING YOUTH SOCCER 2013 / 2014 INSURANCE PROPOSAL PREPARED BY: 2560 RIVER PARK PLAZA, SUITE 300 FORT WORTH, TEXAS (866) PULLENINS.COM

2 2013 / 2014 Coverage Highlights Summary Player Medical and Liability 2013/2014 player medical and liability insurance placements contain the following key highlights: Your player medical insurance policy provides coverage for repetitive motion (hernia) injuries, heat exhaustion claims. Additionally there are no policy coverage restrictions for pre-existing injuries, or the required usage of HMO or similar plan rules for benefit payment consideration. Furthermore, our excess accident medical plans do not limit or restrict coverage involving Durable Medical Equipment or prescription drugs. Most competitors exclude or severely limit coverage in these areas. Emergency Evacuation benefits due to a covered accident or emergency sickness that warrants emergency evacuation while outside a 100 mile radius from their primary resident. (Most competitor medical policies do not have this important benefit rider.) The general liability policy and excess liability policy are written with an unlimited policy aggregate for claims other than products liability and sexual abuse claims. A policy aggregate caps the total amount a policy will pay. A policy with no aggregate pays up to the occurrence limit for each and every claim thereby preventing any depletion of limits and financial exposure to your state association due to multiple catastrophic claims such as those involving goal posts at the same field location. No other competitor provides this coverage enhancement and protection. General liability policy does not exclude coverage for punitive damages as is common with competitor policies. Sexual abuse coverage is written specifically into the primary liability policy at policy limits of 1 million per ocurrance/2 million aggregate. Additional protection is provided in the excess liability policy at the full excess limit purchased. Sexual abuse coverage contains no exclusions for named insureds who should have known about an abusive situation. Player vs. player liability claims are covered under the general liability policy. Coverage applies when a player makes a liability claims against another player. Full liability protection is provided to additional insured field owners under the general liability policy while your clubs are using the athletic fields. There is no restrictive policy language for claims involving their sole negligence. Excess liability protection can be purchased up to limits of $10,000,000. 2

3 Commercial General Liability Coverage Policy Period: September 1, 2013 September 1, 2014 Insurance Company: Schedule of Named Insureds: National Casualty Co. (AM Best Rating A+ Superior) Wyoming Youth Soccer including their leagues, teams, players, coaches, referees, sponsors, directors and officers, officials and volunteer workers while acting on behalf. LIMITS OF INSURANCE General Aggregate Unlimited Products/Completed Operations Aggregate $1,000,000 Personal and Advertising Injury $1,000,000 Each Occurrence $1,000,000 Rented to You Limit $300,000 Medical Expense (Spectators Only) $5,000 Sexual Abuse Each Occurrence $1,000,000 Sexual Abuse Aggregate* $2,000,000 Non-Owned / Hired Auto Liability** $1,000,000 Stop Gap Liability $1,000,000 $1,000,000 Aggregate * The $2,000,000 Sexual Abuse Aggregate applies to the entire program (all named insureds). **For official business of the Named Insured only. No Coverage for any driver transporting soccer players. Coverage Trigger: Deductible: General Liability Occurrence None 3

4 Commercial General Liability Coverage Coverage is provided for: Bodily injury Personal injury Athletic Participant liability Spectator liability Property damage liability Volunteer liability Activities necessary and incidental to the conduct of games or practices Sponsored functions such as meetings, banquets, and fundraisers Contractual liability Hired and non-owned auto liability Worldwide coverage if suits are brought in the United States Host liquor liability Athletic trainers used at tournaments (excess basis) Office premises liability coverage automatically included for state office and your member affiliates Volunteer (medical personnel) providing emergency medical services Covered Activities: Activities which are sanctioned by the state association Major Exclusions: Standard ISO CGL exclusions Employment practices Total pollution Lead Mechanical Rides Water slides Rodeos Coverage Modifications: Additional Insured Government entities and field owners as required, sponsors and co-promoters at no additional premium Schedule of Exposures and Rates: CLASS DESCRIPTION RATING BASIS EXPOSURE RATE PER PARTICIPANT GENERAL LIABILITY PREMIUM Athletic Participants Each Participant 6,500 $0.92 $5,980 4

5 Excess Liability Coverage Policy Period: September 1, 2013 September 1, 2014 Insurance Company: National Casualty Co. (AM Best Rating A+ Superior) Schedule of Named Insureds: Wyoming Youth Soccer Coverage Form: Following Form Excess LIMITS OF INSURANCE Aggregate Limit Unlimited Products/Completed Operations Aggregate $3,000,000 Each Occurrence $3,000,000 Sexual Abuse Aggregate $3,000,000 Each Occurrence $3,000,000 Coverage Modifications: Notable Endorsements: See policy for specific information pertaining to these modifications Employers Liability Exclusion, Directors & Officers Exclusion, Auto Follow Form Endorsement, Liquor Liability Exclusion, and Mold Exclusion Schedule of Exposures & Rates: CLASS DESCRIPTION RATING BASIS EXPOSURE RATE PER PARTICIPANT EXCESS LIABILITY PREMIUM Athletic Participants Each Participant 6,500 $0.33 $2,145 5

6 Excess Accident Policy Period: September 1, 2013 September 1, 2014 Insurance Company: Schedule of Named Insureds: Covered Activities: Accident Group Coverage National Union Fire Ins. (AM Best Rating A Excellent) Wyoming Youth Soccer including their leagues, teams, players, coaches, referees, sponsors, directors and officers, officials and volunteer workers while acting on behalf. While participating in scheduled games, team practice sessions, or sponsored activities, provided they are under the direct supervision of a team official or a sanctioned local or national tournaments as a member of a contestant team. Includes organized and supervised group travel as authorized by the policyholder directly to and from a covered event. LIMIT (PER CLAIM) DESCRIPTION Excess Accident Coverage Medical and $500 Flat Dental Maximum Deductible $100,000 Accidental Death Benefit and Dismemberment N/A $5,000 Benefit Period 52 weeks Physical Therapy/Chiropractic Limit $2,000 max $50 per visit Accident Rates CLASS DESCRIPTION RATING BASIS EXPOSURE RATE PER PARTICIPANT MEDICAL PREMIUM Athletic Participants Each Participant 6,500 $2.64 $17,160 6

7 Annual Premiums Total 13/14 Player Rate: $3.89 Total 12/13 Player Rate: $3.52 Total 11/12 Player Rate: $3.52 Total 10/11 Player Rate: $3.52 Total 09/10 Player Rate: $3.52 Total 08/09 Player Rate: $3.52 Total 07/08 Player Rate: $3.53 Total 06/07 Player Rate: $ / 2014 Premium Billing: Player Medical, Liability, and Excess Liability premiums are billed in ten (10) consecutive monthly payments (excludes any premium charge if Certified Acts of Terrorism coverage is selected). $6,322 Due 9/1/13 $2,107 Due 2/1/14 $2,107 Due 10/1/13 $2,107 Due 3/1/14 $2,107 Due 11/1/13 $2,107 Due 4/1/14 $2,107 Due 12/1/13 $2,107 Due 5/1/14 $2,107 Due 1/1/14 $2,107 Due 6/1/14 Note: If Certified Acts of Terrorism coverage is selected the additional annual cost is: General Liability and Excess Liability $

8 2560 RIVER PARK PLAZA, SUITE 300 FORT WORTH, TEXAS (866) PULLENINS.COM Wyoming Youth Soccer Acceptance Confirmation To: Re: Pat Pullen Pullen Insurance Services, Inc. or (817) Fax Wyoming Youth Soccer 13/14 Player Insurance Please initiate coverage for the player medical and liability insurance for the period September 1, 2013 September 1, Attached is the acceptance / rejection form for the election of Certified Acts of Terrorism coverage. Signature 7/3/2013 Date 8

9 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE TERRORISM RISK INSURANCE ACT Under the Terrorism Risk Insurance Act of 2002, as amended, pursuant to the Terrorism Risk Insurance Program Reauthorization Act of 2007, effective January 1, 2008 (the Act ), you have a right to purchase insurance coverage for losses arising out of acts of terrorism, as defined in Section 102(1) of the Act: The term certified act of terrorism 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 an air carrier or vessel or the premises of a United States mission; to have been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, 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. You should know that where coverage is provided by this policy for losses resulting from certified acts of terrorism, such losses may be partially reimbursed by the United States Government under a formula established by federal law. 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 premium for this coverage is shown below and does not include any charges for the portion of loss covered by the Federal Government under the Act. You should also know that the Act, as amended, contains a $100 Billion Cap that limits United States Government reimbursement as well as insurers' Liability for losses resulting from "certified acts of terrorism" when the amount of such losses in any one calendar year exceeds $100 billion. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. CONDITIONAL TERRORISM COVERAGE The federal Terrorism Risk Insurance Program Reauthorization Act of 2007 is scheduled to terminate at the end of December 31, 2014, unless renewed, extended or otherwise continued by the federal government. Should you select Terrorism Coverage provided under the Act and the Act is terminated December 31, 2014, any terrorism coverage as defined by the Act provided in the policy will also terminate. IN ACCORDANCE WITH THE ACT, YOU MUST CHOOSE TO SELECT OR REJECT COVERAGE FOR "CERTIFIED ACTS OF TERRORISM" BELOW: xx I hereby elect to purchase certified terrorism coverage for a premium of $ I understand that the federal Terrorism Risk Insurance program Reauthorization Act of 2007 may terminate on December 31, Should that occur my coverage for terrorism as defined by the Act will also terminate. I hereby reject the purchase of certified terrorism coverage. Policyholder / Applicant's Signature SANDY JENKIN Print Name Wyoming Youth Soccer Named Insured / Firm TBD Policy Number, if available 7/3/2013 Date NOTN0164CW (1-08) 9

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