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��j Arch Insurance <br />r <br />ARCH INSURANCE COMPANY <br />(A Missouri Corporation) <br />Home Office Address: <br />2345 Grand Blvd, Suite 900 <br />Kansas City, MO 64108 <br />Administrative Address: <br />Harborside 3 <br />210 Hudson Street, Suite 300 <br />Jersey City, NJ 07311-1107 <br />Tel: (866) 413-5550 <br />COMMERCIAL EXCESS LIABILITY CERTIFICATE HOLDER DECLARATIONS <br />Certificate Number: <br />This Certificate Forms a Part of Master Policy Number: <br />SBFXS0045204 <br />SJ FXS0000904 <br />Policy Period: FROM: 07/01 /21 <br />TO: 07/01 /22 <br />at 12:01 A.M., Standard Time at your mailing address shown below. <br />Named Insured: <br />U.S. Soccer Foundation, Inc. dba U.S. Soccer Foundation <br />Named Insured Mailing Address: <br />1140 Connecticut Ave., NW, Suite 1200, <br />Washington, DC 20036 <br />Business Description: <br />Soccer Foundation <br />Form of Business: <br />Organization, including a Corporation <br />Producer Name: <br />American Specialty Insurance & Risk Services, Inc. <br />Producer Mailing Address: <br />7609 W. Jefferson Blvd., Suite 100, Fort Wayne, IN 46804 <br />Retroactive Date (if any): <br />N/A (Applicable to Claims -Made Coverage Only) <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, WE AGREE TO PROVIDE YOU WITH THE INSURANCE AS STATED IN THIS POLICY. <br />Excess Policy — Limits Of Insurance <br />Each Occurrence Limit <br />$3,000,000. <br />Aggregate Limit <br />$3,000,000. <br />Other: <br />$ <br />Excess Policy - Premium <br />Certificate Premium (including premium subject to audit) <br />Certificate Premium for Certified Acts of Terrorism: <br />(Included within the Certificate <br />Premium) <br />Audit Period (if applicable) <br />❑ Annual ❑ Semi -Annual ❑ Quarterly ❑ Monthly <br />05 SXS0002 00 10 Includes copyrighted material from Insurance Service <br />16 Office, Inc., with its permission. <br />�oRaN <br />or <br />RAMmWmedDMsfan <br />REVIEWED & APPROVED BY.- <br />f R. W&Wd <br />Risk Management Analyst <br />