Sports Instructor Application
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NOTE TO ALL AGENTS AND BROKERS: This program does not pay a commission to agents and brokers
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This insurance program has been specifically designed to meet the unique needs of a U.S.-based sports instructor directly supervising an individual or a group engaged in sports-related skills.
This program does not provide coverage for the operation, ownership or maintenance of a fitness, sports or dance facility. If coverage is needed for a facility, please contact 800-622-7370.
Coverage is provided by a carrier rated A+ (Superior) by A.M. Best Company.
I agree that I have reviewed and acknowledge the General Fraud Statement and Electronic Disclosure and Consent. The email used during this application is the email I wish to use for all correspondence.
I have reviewed all coverage descriptions and exclusions found on the print application.
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.
Costs are fully earned and non-refundable once coverage begins.
I agree to the following:
Application for this plan may be made 01-01-2019 through 12-31-2019. After this date, new applications will be subject to changes in rates and coverages.
The submission of this enrollment form and/or the acceptance of payment does not guarantee coverage. Completion of this enrollment form confirms the individual's desire to obtain insurance coverage through the Sports, Leisure & Entertainment Risk Purchasing Group. 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 instructor. Coverage applies for one or two full years from your effective date depending on which option of coverage you chose. For example: 1 Year Premium: 05/01/19 - 05/01/20 or 2 Year Premium: 05/01/19 - 05/01/21.
I understand that this coverage is for a U.S.-based sports instructor age 18 or older, directly supervising an individual or a group engaged in sport-related skills. Eligible activities include:
- Baton Twirling
- Cross Country
- Figure Skating
- Road Running
- Table Tennis
- Track & Field
- Tumbling (floor only, no gymnastics apparatus)
* for instruction of dance only, please visit www.sadlersports.com/dance-instructor
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. Click Here to be redirected to our Health/Fitness Club Coverage or Dance Studio Coverage
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:
- Certified athletic trainer
- Instructor under the age of 18
- Coaching of organized competitive athletic teams
- Instructor's employment as an exempt or non-exempt employee of a school, university or college
- Instruction in any of the following activities: Boxing, Canoeing, Cycling, Diving, Equestrian, Gymnastics, Kayaking, Lifeguarding, Martial Arts, Rowing, Scuba Diving, Skiing, Surfing.
Exclusions: 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 or any device that is specifically designed for the training or instruction of the activity for which you are enrolled); Animals (injury or death to, or injury, death or property damage caused by any animal owned, rented or hired by you); Asbestos; Commercial general liability standard exclusions (CG0001 04/13 edition); Cryogenic Chambers/therapy; Cycling (other than stationary); Employment-related practices; Fireworks; Fungi or bacteria; Haunted attractions; Instruction/activities held on or in open water (ex: lakes, ponds, ocean.); Lead; Medical therapy or health care services; Nuclear energy liability; Operation, ownership or management of a commercial or sports facility; Performers; Physicals/stress testing; Physical therapy, massage or salon services; Rodeos; Saddle animals; Sale or distribution of medicinal, herbal and/or nutritional products; Snowmobile; violation of statutes that govern e-mails, faxes, phone calls or other methods of sending material or information. Those operations listed as ineligible: Certified athletic trainers, Coaching of organized competitive athletic teams, Instruction of the following sports: Canoeing, Cycling, Diving, Equestrian, Gymnastics, Kayaking, Lifeguarding, Martial Arts, Rowing, Scuba Diving, Skiing, Surfing, Instructors under the age of 18, Instructor's employment as an exempt or non-exempt employee of a school, university or college.
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.
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 further acknowledge that I have reviewed all information under the "print application" section of this website and understand the exclusions that apply, as well as the activities and operations for which coverage is not provided.
I am aware that premium is fully earned at inception.
I understand that this online enrollment provides the option for us to select General Liability. However, we offer 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. I am interested in a quote for these other types of policies, I will need to inform Sadler in writing, firstname.lastname@example.org.
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 email@example.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.
If you've already purchased insurance with Sadler & Company and need to access to your verification of coverage documents or add an Additional Certificate click here to recover your information. The email address attached to your account will need to be supplied.
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