In order to accept the terms you must read and scroll to the bottom.
I, (The Above Named) as authorized signatory for (Above Track Name) do accept and agree to comply with all safety, insurance and sanction requirements as set forth in the QSAC Track Sanctioning Package. As authorized signatory for the above designated facility, I agree that if such requirements are not complied with, sanction shall be subject to immediate revocation and any and all insurance rescinded unless and until the requirements are met.
This application must be completed and accompanied by the Affiliated Club Application together with appropriate documentation as defined in the “Track Sanctioning Requirements” in order to obtain sanctioning and insurance. Sanction requires insurance and insurance requires sanction.
Sanction Insurance is provided to protect the owner, lessee of a race site, or the sponsor of a club or racing event. Coverage is for personal or property liability of $1,000,000.00 with a yearly cost of $50.00 for the first certificate issued. The single race event cost is $30.00 (please see notes on page #2 under item #12.)
Premiums are for the calendar year, or any part thereof. Insurance expires on January 15th of each year, to coincide with QSAC’s annual policy renewal date.
Club Affiliation Application (where applicable)
The insurance coverage provided by QSAC is written to provide for all affiliated clubs under the master policy. The insurance carrier requires compliance with the following conditions in order to qualify as a QSAC Affiliated Club:
1. The Club must file with QSAC a completed form providing Club Name, Mailing Address and a list of Officers of the Club.
2. That each event organized by the affiliated club observe and enforce QSAC Safety Rules, Guidelines and Standards.
3. That each participant in each event be a QSAC member in good standing.
A Certificate of Insurance will be e-mailed to all clubs filing the appropriate forms and fees with the QSAC Secretary/Treasurer: Doreen Brown.
Sanctioned event applications should be routed through your QSAC Region or Area Director.
Note: The Certificate of Insurance provided at the time of club affiliation should be sufficient in most cases to satisfy the requirements of the site owner. You should provide the site owner or his representative a copy of your Certificate of Insurance. Only if the site owner requires a Certificate of Insurance specifically naming him as “Additional Insured” under the policy do you need to add his name as additional insured.
Please fill out the following for payment. Your application can NOT be submited without payment online. If you would prefer to write a check you may PRINT the current application and mail it along with your check payment.