This program has been designed for U.S.-based martial arts and/or self defense instructors who work on an independent contractor basis training individuals in martial arts and/or self defense. This could include self defense instructors, law enforcement/security defense tactic instructors or martial arts instructors. Coverage provided under this program includes commercial general liability protection for the instructor for liability claims arising out of their operations while training.
This program does not provide coverage for the operation, ownership or maintenance of a fitness, sports or dance facility. If I do own, operate or maintain a fitness, sports or dance facility, this coverage will not extend to the facility. I must purchase a general liability policy for the facility itself.
to be redirected to our Martial Arts Schools Insurance Full Coverage Limits, Exclusions, Ineligible Activities, Fraud Statements, etc.
Costs are fully earned and non-refundable once coverage begins.
I agree to the following:
Application for this plan may be made 03/01/2022 through 12/31/2022. 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 Administration fee may be charged. The submission of this enrollment form and/or acceptance of payment does not guarantee coverage. Certain operations are not eligible for coverage by this program. We reserve the right to decline any request for coverage.
Coverage Effective Dates
Annual 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. Coverage will expire on year from the effective date.
Single Event Coverage:Coverage begins on the first day of the event listed on the enrollment form assuming the form is received and approved concurrent with the payment of the entire premium and will expire 12:01 a.m. the date following the last date of the event. Coverage is only provided for the dates listed on the enrollment form.
The premium computation section must be completed as applicable. Please note that all rates are per instructor. I understand that I must be over the age of 18 to qualify for this coverage.
I understand that this coverage is for U.S.-based martial arts and/or self defense instructors who work on an independent contractor basis training individuals in martial arts and/or self defense. This could include self defense instructors, law enforcement/security defense tactic instructors or martial arts instructors.
An instructor age 18 or older conducting private or group instruction in any of the following is eligible to enroll in this program:
Brazilian jiu jitsu
Mixed martial arts or ultimate fighting
Tang soo do
Jeet kune do
Coverage will only be provided for the types of instruction listed on the application.
If applying as a certified instructor, a copy of the certification may be requested at any time.
I understand that the following are Ineligible Operations under this policy/Operations not eligible for this program include but are not limited to the following:
Tournaments or competitions
Certified athletic trainers
Instructors under the age of 18
Coaching of organized competitive athletic teams
Military/paramilitary combat training
Your employment as an exempt or nonexempt employee of a school, college or university.
The following notable exclusions are contained in the commercial general liability coverage provided by this program (note: state variations may apply). Abuse, molestation, or exploitation; Asbestos; Commercial general liability standard exclusions (CG001 4/13 edition); Cap on losses from certified acts of terrorism; Communicable disease; Cryogenic chambers/therapy; Cyber incident, data compromise, and violation of statutes related to personal data; Cycling (other than stationary); Employment related practices; Fireworks; Fungi or bacteria; Instruction/activities held on or in open water (e.g.: lakes, ponds, ocean); Lead; Medical, therapy or health care services; Nuclear energy liability; Operation, ownership or management of any facility; Physicals/stress testing; Physical therapy, massage or salon services; Sale or distribution of medicinal, herbal and/or nutritional products; Sexually transmitted disease; Silica or silica-related dust; Specified recreational activities – Aircraft/hot air balloon; Airport; Amusement devices: The ownership, operation, maintenance or use of any device or equipment a person rides for enjoyment, including, but not limited to: mechanical or non-mechanical ride, slide, or water slide (including any ski or tow when used in conjunction with a water slide); inflatable recreational device, or vertical device or equipment used for climbing whether permanently affixed or temporarily erected. This exclusion does not apply to video or computer games; Animals; Bungee; Dunk tank; Haunted attraction; 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. This exclusion does not apply to participants in any activity, event or exhibition that are part of the designated operations for which you are enrolled; Rodeo; Saddle animal; Snowmobile; Total pollution with a building heating, cooling & dehumidifying equipment exception and hostile fire exception; Use of projectile weapons including, but not limited to, firearms and tasers, and defense sprays; Use of sharpened/bladed weapons; Unmanned aircraft; Those operations listed as ineligible: The sport of boxing (contact/sparring); Certified athletic trainers; Coaching of organized competitive athletic teams; Firearms training; Instructors under the age of 18; Military/paramilitary combat training; Tournaments or competitions; Your operations related, in whole or in part, to your employment as an exempt or non-exempt employee of a public or private school, college or university; 100% virtual operations/training.
GENERAL FRAUD STATEMENT
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 who 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 prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written, electronic, electronic impulse, facsimile, magnetic, oral, or telephonic communication or 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 MN:
A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.
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.
Applicable in VT:
Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.
Applicable in all other states: 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.
The undersigned authorized officer of the applicant declares that the statements set forth herein are true to the best of his or her knowledge. The undersigned authorized officer agrees that if the information supplied on the application changes between the date of the application and the effective date of the insurance, he/she (undersigned) will immediately notify the insurer of such changes, and the insurer may withdraw or modify any outstanding quotations and/or authorization or agreement to bind the insurance. Signing of this application does not bind the applicant to the insurer to complete the insurance.
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 operation for which coverage is not provided.
I understand that this online enrollment provides the option for the insured 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 I am interested in a quote for
these other types of policies, I will need to inform Sadler in writing, firstname.lastname@example.org
RECEIPT OF COVERAGE DOCUMENTS:
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&
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.