I agree that I have reviewed and accept the terms of the Copyright Notice, Legal Notice and Privacy Policy that can be found in the links at the bottom of this page.

In the event that Sadler & Company determines that the applicant does not qualify for this program, has not accurately answered a question, or has tendered an invalid check or one with insufficient funds, all coverages will immediately be voided as of the effective date and notify all certificate holders.

I understand that the insurance company, in determining whether to provide insurance coverage, will rely on the information contained in this form and all other information being submitted. I hereby warrant, represent and confirm that, to the best of my knowledge, all information provided is complete, true and correct.

I am aware that the insurance company expects accurate reporting for my premium calculation. I understand that my books and records may be examined or audited by the insurance company at any time during the coverage period and up to three years afterwards. Intentional misrepresentation or misreporting may jeopardize coverage.

I further acknowledge that I have reviewed all information provided with this enrollment form and understand the exclusions that apply, as well as the activities and operations for which coverage is not provided.

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Costs are fully earned and non-refundable once coverage begins.

I agree to the following:

Application for this plan may be made 04/01/2017 through 03/31/2018. After this date, new applications will be subject to changes in rates and coverages.

Completion of this enrollment form confirms your desire to obtain insurance through the Sports, Leisure and Entertainment Risk Purchasing Group. An RPG provides group purchasing power for similar risks resulting in potential advantageous coverage terms, competitive rates, risk management bulletins, and rewards for favorable group loss experience. An RPG membership fee may be charged. The submission of this enrollment form and/or the acceptance of payment does not guarantee coverage. Certain operations are not eligible for coverage by this program. Sadler & Company reserves the right to decline any request for coverage. Coverage begins on the date after the enrollment form is received and approved concurrent with the payment of the entire premium or, a later effective date can be requested.

The premium computation section must be completed as applicable. Please note that all rates are per entertainer. Coverage applies for one year from effective date (one year coverage) OR 12:01 a.m. the date following the last date of your single event/show (single event coverage-no more than 10 days.) Coverage is effective the date after we receive the completed enrollment form and the appropriate premium or the first date of the single event depending on the option chosen.

I understand that I must be over the age of 18 to qualify for this coverage. I also understand that the annual gross income from the entertainer's or performer's activities cannot exceed $300,000.

I understand that this coverage is for a U.S.-based entertainers and performers who work on an independent contractor basis entertaining at local fairs, festivals, special events, private parties, conventions or tradeshow booths. Eligible activities include:

• Actor portraying historical person (actual or fictional)
• Balloon artist
• Belly dancer
• Caricature sketching
• Celebrity look-alike
• Clown
• Comedian
• Conductor
• Contortionist
• DJ or KJ
• Face/body painter (FDA approved/compliant paint only)
• Holiday character
• Impersonator
• Impressionist
• Juggler
• Magician
• Mime
• Musician, singer or vocalist
• Poet
• Puppeteer
• Story teller
• Ventriloquist
• Western performer
• Yodeler

Coverage will only be provided for the types of instruction listed on the application.

I understand that the following are Ineligible Operations under this policy:

• Acrobatic or aerialist performer
• Actor or Actress
• Circus performer
• Cosmetologist/Beautician
• Escape artist
• Exotic dancer
• Fire handler
• Group acts or bands
• Henna/Mehndi artist
• Hypnotist
• Jouster
• Mascot (college, high school, professional)
• Model
• Performer putting on an athletic exhibition
• Performer using weapons (live ammunition or sharpened blades)
• Permanent tattoo and/or body piercing artist
• Production/Entertainment companies
• Public speaker
• Pyrotechnician
• Rap, hip-hop, alternative or techno musical entertainer/performer/DJ
• Strength performer
• Stripper
• Stunt performer
• Touring entertainer / performer

Coverage Exclusions: The following exclusions are contained in the commercial general liability coverage provided by this program. Abuse, molestation, harassment or sexual conduct; Aircraft/hot air balloon; Airport; Amusement devices (The ownership, operation, maintenance or use of: any mechanical or non-mechanical ride, slide, or water slide, any inflatable recreational device, any bungee operation or equipment, any vertical device or equipment used for climbing-either permanently affixed or temporarily erected, or dunk tank. Amusement devices do not include any video or computer games); Animals (injury or death to, or injury, death or property damaged caused by any animal owned, rented or hired by you. However, rabbits, doves, mice, hamsters, non-venomous/non-constricting snakes and dogs weighing less than 15 lbs. are covered for the liability arising out of the insured's operations that include the use of these animals); Asbestos; Athletic activity; Body surfing or mosh pits; Commercial general liability standard exclusions (CG0001 04/13 edition); Employment-related practices; Events hosted/organized by the entertainer/performer; Fireworks (However, this exclusion does not apply to flashboxes. As used in this environment, flashboxes means a device used to create a visual effect along with an explosive noise and is induced electronically in a cylinder with no projectile, wadding or wrapping); Full body art/painting; Fungi or bacteria; Haunted attractions; Historical battle re-enactment; Hot wax impressions; Lead; Nuclear energy liability; Ownership of a facility for performances; Personal and advertising injury; Performer (Injury or death to any performer or entertainer during any activity, event or exhibition including but not limited to any stunt, concert, show or theatrical event.); Rodeos; Saddle animals; Snowmobile; Use of any substance to paint or apply on the face or body that is not classified as non-toxic and/or manufactured using only FDA compliant ingredients; Violation of statutes that govern e-mails, faxes, phone-calls or other methods of sending material or information; Those operations listed as ineligible: Acrobatic or aerialist performer, Actor or actress, Circus performer, Cosmetologist/Beautician, Escape artist, Exotic dancer, Fire handler, Group acts or bands, Henna/mehndi artist, Hypnotist, Jouster, Mascot (college, high school, professional), Model, Performer/entertainer under the age of 18, Performer putting on an athletic exhibition, Performer using weapons (live ammunition or sharpened blades), Production/entertainment companies, Public speaker, Pyrotechnician, Strength performer, Stripper, Stunt performer, Permanent tattoo or body piercing artist, Rap, hip-hop alternative or techno musical entertainer/performer/DJ.

I agree that I have reviewed the complete brochure, including all general fraud statements, warranty statements, ineligible operations and coverage exclusions located http://www.sadlersports.com/entertainersinsurance/pdf/app-entertainers-performers.pdf

Coverage is provided by a carrier rated A+ (Superior) by A.M. Best Company.

I understand that the insurance company, in determining whether to provide insurance coverage will rely on the information contained in this form and all other information being submitted. I hereby warrant, represent and confirm that, to the best of my knowledge, all information provided is complete, true and correct.

I am aware that the insurance company expects accurate reporting for my premium calculation, and should my figures exceed my estimates during the coverage term I will make arrangements to pay the additional premium. I understand that my books and records may be examined or audited by the insurance company at any time during the coverage period and up to three years afterwards. Intentional misrepresentation or misreporting may jeopardize coverage.

I am aware that this online enrollment provides the option for me to select General Liability. However, Sadler offers other types of insurance policies that are not available on this online enrollment such as Medical Expense, Workers' Compensation, Excess Liability, Property (building and contents), Equipment, Event Cancellation, Cyber Risk, Business Auto, Professional Liability, etc. If you are interested in a quote for these other types of policies, I will need to inform Sadler in writing, sport3@sadlersports.com.

Applicable in AL, AR, DC, LA, MD, NM, RI and WV - Any person who knowingly (or willfully)* presents a false or fraudulent claim for payment of a loss or benefit or 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. *Applies in MD only.

Applicable in CO - It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

Applicable in FL and OK - Any person knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony (of the third degree)*. *Applies in FL only.

Applicable in KS - Any person who knowingly and with intent to defraud, presents, causes to be presented or prepared with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act.

Applicable in KY, NY, OH and PA - Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties* (not to exceed five thousand dollars and the stated value of the claim for each such violation)*, *Applies in NY only.

Applicable in ME, TN, VA and WA - It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties (may)* include imprisonment, fines and denial of insurance benefits. *Applies in ME only.

Applicable in NJ - Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.

Applicable in OR - Any person who knowingly and with intent to defraud or solicit another to defraud the insurer by submitting an application containing a false statement as to any material fact may be violating state law.

I understand that I will only receive electronic copies of insurance documents and will not receive paper copies.

I understand that the files contained in my proof of coverage email are important documents. Once these documents are received, I will review and make sure the documents contain the coverages requested and further agree to notify Sadler & Co., Inc. if the documents have any mistakes in coverages and/or limits. I am aware that because this coverage is written on a master policy, only the certificate of insurance and the verification of coverage will be provided. However, a copy of the master policy is available at any time by emailing a request to events@sadlersports.com

If I do not get email containing my proof of coverage documents within 24 hours, I will follow-up with Sadler & Company immediately.

I acknowledge that my address below is correct and will update Sadler & Co., Inc. of any changes to this email in the future. I grant permission to Sadler & Co., Inc. to utilize this email address to send all documents electronically, including but not limited to, certificates of insurance, verification of coverage, underwriting questions, coverage changes, quarterly newsletters and important messages.