Club Liability Application

This annual coverage is for clubs; associations and organizations and their members for general activities on and off water. It includes, but is not limited to, training, practices, coaching, club/association cruises, meetings, banquets, small fundraisers (excluding racing fundraisers), recruiting, demonstrations, club/association social events. This is NOT for racing events or special events where members of the public are paying to participate in a race, cruise or demonstration.

To access this program your club or association must be a member of Paddlesport Risk Management, LLC. Annual membership is $25 and non refundable.

PLEASE NOTE: ALL PREMIUM ON ANNUAL CLUB INSURANCE IS FULLY EARNED AND NON-REFUNDABLE.

What are you doing today?*

New to the PRM ProgramRenewing Coverage

NAME OF CLUB/ASSOCIATION/ORGANIZATION*

CLUB MAILING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Insurance Contact*

First NameLast Name

Designation: (ie President, VP, Treasurer,etc)*

CONTACT EMAIL *

example@example.com

CONTACT PHONE NUMBER *

Area CodePhone Number

Does Club Own/Lease Equipment?:

BoatsDockClubhouseother

DOES CLUB LEASE/BORROW/RENT BOATS? If yes, indicate name and address of boat owners.

If owner of boats is not the club please add name of owners

WHAT IS YOUR 'PADDLING' SEASON? - Indicate months or year round.*

HOW MANY TOTAL MEMBERS IN THE CLUB/ORGANIZATION?*

HOW MANY ARE ACTIVE MEMBERS? ("Active members" are those that participate in On and/or off water activities even if they participate in 1 paddling session or social function. Members that pay their dues but do not participate in any on or off water activities are referred to as "inactive members")*

DOES YOUR CLUB MAINTAIN DIRECTORS & OFFICERS LIABILITY?

What is the body of water you paddle in most frequently for training - ? *

NAME OF LAKE, RIVER, OCEAN AND LOCATION

ADDRESS OF PHYSICAL LOCATION (If different from mailing address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

201+ Members Class I-II Base Premium

PREMIUM CALCULATION

USE THE NUMBER OF ACTIVE PADDLERS

Definitions:

Active - A member that participants in 1 or more off and/or on water club activities.

Non-Active - A member that pays member dues but does not participate in any club activities. They support the club financially.

CHOOSE CLASS OF WATER MOST FREQUENTLY PADDLED BELOW. Please call for help with this section if necessary. (631) 321-6859

Hover over class code if you are not sure which one to select:

CLASS I-II

2-50 MEMBERS $43251-100 MEMBERS $785101 - 200 MEMBERS $1150

CLASS I-II 201+ MEMBERS

$8.05 per member

# members *

Enter # members

CLASS III

2-50 members $51051-100 members $960101 - 200 members $1415

CLASS III 201+ MEMBERS

$9.17 per member

# members*

201+ Members CLASS III Base Premium

CLASS III-IV (Water is primarily class III with sections of class IV)

2-50 members $57051-100 members $1069101-200 members $1576

CLASS III-IV 201+ MEMBERS (see above class description)

$10.83 per member

# members*

201+ Members CLASS III-IV Base Premium

SAILBOATS - Club Owned - Liability

$227 Per Boat

# Boats*

SAILBOAT TOTAL

NON REFUNDABLE: Annual Risk Program Membership Fee - the pre-paid option is for clubs that joined new to program between Sept-Dec 2024*

$25 ( All Clubs except those noted below)Pre-paid between 09/01/2024 - 12/31/2024 as a new club to program

ADDITIONAL INSUREDS REQUIRED*

NOYES ($20 per entity)

# Additional Insureds*

Enter number of entities

Subtotal - additional insureds

PLEASE READ BEFORE SELECTING CERTIFICATE TYPE:

The Waiver of Subrogation and Primary Non-Contributory Endorsements are no longer be issued as separate endorsements. These are now part of the common policy terms and conditions as a blanket endorsements. This saves time for the insurance company not having to issue separate endorsements. A certificate will be issued with the applicable endorsement numbers and copy of the policy forms.

You must provide the correct name and address. Failure to do so will cause delays issuing your certificates and you will not be given priority if changes are required.

IF YOU HAVE NOT BEEN ASKED TO PROVIDE ANY ENDORSEMENTS DO NOT CHECK THE ENDORSEMENT BOX. You will be provided a certificate of insurance.

If specific wording is requested please type into the comments box at the bottom. ONLY REQUEST ENDORSEMENTS IF YOU HAVE BEEN INSTRUCTED BY THE CERTIFICATE HOLDER otherwise check the Additional Insured Certificate box only.

1) Additional Insured Certificate2) Waiver of Subrogation - Blanket Endorsement3) 30 Days Cancellation Notice4) State or Municipality Endorsement CG 20-125) Additional Insured Person/Organization Endorsement CG 20-266 ) Primary non-contributory Blanket Endorsement

If more than 6 are required please submit a separate request using the Additional Insured Request Form on our website. www.paddlesportriskmanagement.com. DO NOT EMAIL US THE NAME AND ADDRESS or it may be missed by certificate processing.

Type in full address - do not type "same as last year". If an address is not provided it will not be issued.

1) Additional Insured

2) Additional Insured

3) Additional Insured

4) Additional Insured

5) Additional Insured

6) Additional Insured

DIGITAL WAIVERS:

A digital waiver system is available for clubs to access. Your club name and/or logo can be added to the approved PRM waiver. Any specific wording/information lines can also be added. (discussed prior to creation of waiver). We recommended using a generic email address for notifications of a signed waiver to go to. You will not be required to mail or email copies of club waivers as our office will download at the end of the season. This reduces the responsibility of a member having to collect paper waivers. You will be given a link to post to your websites/social media pages or to email to members and guests. You will have access to a back office where you will see all signed waivers and be able to download. It is a simplifed cost effective system for clubs looking to reduce the use of paper. A PDF waiver is also provided.

The cost is $35 per year.

CHOOSE TYPE OF WAIVER - You may use both PDF and E waiver*

PDF WaiverPRM E-Waiver - Renewal - $35PRM E-Waiver New- $35USING Alternative E-Waiver system

Email address all notifications of a signed waiver will be forwarded to:

example@example.com

Use the upload feature to attach a copy of your logo or any other document you wish to submit with this application. If you have previously provided it you will not need to submit it unless it needs to be updated.

UPLOAD YOUR FILE

( gif, png, jpg, jpeg formats)

TOTAL PREMIUM DUE

TERMS AND CONDITIONS

Acceptance of this proposal confirms your desire to obtain insurance as a member of Paddlesport Risk Management, LLC under it's club liability program. I hereby certify that the safety requirements of Paddlesport Risk Management, LLC (PRM) and US Coast Guard or state laws, whichever is stricter, will be adhered to during club activities. I further understand that all PFD's used are USCoast Guard class I, II,III or V approved and that all members and guests will sign the PRM approved release of liability waiver or one that your club has had approved by PRM.

Enter name to accept terms & conditions

First NameLast Name

COMMENT

LEAVE A COMMENT OR SUGGESTION TO HELP US IMPROVE OUR SERVICES

Payment - Please indicate payment method. If mailing - application will not be processed until check is received. Your check will be processed electronically. You will not receive the cashed check. PLEASE NOTE: WE DO NOT SEND OUT INVOICES PREMIUM MUST BE PAID ONLINE OR BY MAIL*

Mail (see mailing info below)Online (No vendor fee for check payment. Vendor fee accessed for credit/debit card. You will be redirected after you submit your application)

Mail in payment: Make check payable to Paddlesport Risk Management, LLC

Mail to: PO Box 668, Kings Park, NY 11754

Phone: (631-321-6859)

A COPY OF THIS APPLICATION WILL BE EMAILED TO THE EMAIL ADDRESS PROVIDED

PADDLES UP!!

2025 ANNUAL CLUB LIABILITY APPLICATION