Event Liability Application

2025 SPECIAL EVENT APPLICATION

This coverage is for any non-motorized watercraft racing, festivals, demonstrations, cruises, workshops, kayak and canoe camping, kayak/canoe angling, training camps, SUP, floats, indoor /outdoor ergo-meter, kayak angling, sailing regattas; biathlons and triathlons (all Athlons must include a non motorized watercraft leg). Class III-IV is class III with periodic stretches of class IV - must be predominantly class III.
IF YOU HAVE QUESTIONS WHILE COMPLETING THIS APPLICATION CONTACT

Ph: (631) 321-6859
EVENT NAME:*
EVENT DATE*

MonthDayYear
MULTI-DAY EVENT END DATE ( Must be consecutive)

MonthDayYear
MULTI-DAY EVENTS MUST BE CONSECUTIVE
PRE EVENT PRACTICE/SETUP DATE/S
Insert start and end date
Provide a detailed description of the course of the event, eg: name of body of water & location, classification of water, any hazards along the course.*
Provide detailed description of all safety measures and emergency services available at the event. If no emergency services at the event please explain procedures in place in the event of a medical emergency or other type of incident.*
Will there be a safety briefing before any participant enters the water informing participants about any hazards on the course, emergency services etc?*

YESNO - If no please check "Other" option and explain reasonOther
EVENT HOST/ORGANIZER*
Name of Organization/Individual/Club organizing event
CONTACT NAME*

First NameLast Name
CONTACT MAILING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CONTACT EMAIL - if an incorrect email is entered you will not receive your insurance documents*
example@example.com
CONTACT PHONE NUMBER *
Acceptance of this proposal confirms your desire to obtain insurance through the Sports, Leisure, & Entertainment Risk Purchasing Group.

I hereby certify that requirements of Paddlesport Risk Management, LLC (PRM); US Coast Guard or state laws, whichever is stricter, will be adhered to during the event. I further understand that all PFD's used are US Coast Guard approved and that all participants will sign the PRM approved release of liability waiver. I understand that copies of waivers MUST be returned to PRM administrators office within 14 days post event, via upload on PRM website, mail, fax or email.
Typing your name is acceptance of the conditions and terms of coverage.*

First NameLast Name
PREMIUM CALCULATION

If you over estimate premium calculations you will receive a refund. If you underestimate and have more participants than estimated you will pay the balance with the post event audit and waiver submission.
Not sure what class you are.

Level = Class

Hover over picture to see classifications
Enter type of vessels in event ( you may select multiple types) - SUP FOILING AND E-FOILING ARE NOT COVERED UNDER THIS PROGRAM CONTACT OUR OFFICE FOR A SEPARATE APPLCIATION*

OutriggerDragon BoatSUP/Surf Ski/PaddleboardCanoe/KayakSailing - small sailboatsKayak AnglingRowing Regatta
SELECT ONE.*

Less than 18 participantsMore than 18 participants
EVENT TYPE - Less than 18 PARTICIPANTS - This is the minimum premium for coverage*

RACING CLASS I-II - $100 Flat RateRACING CLASS III - $110 Flat RateRACING CLASS III-IV (primarily class III with sections of class IV) - $125 Flat RateNON RACING/ CRUISING/PLEASURE PADDLING/SYMPOSIUMS $100WORKSHOP/NON MEMBER TEAM BUILDING/CANOE-KAYAK CAMPING/ PADDLE TRAINING CAMP $100BIATHLON - $150TRIATHLON - $180ERG INDOOR/OUTDOOR - $70
#Participants - (18 or less) *
ENTER NUMBER OF PARTICIPANTS
Less than 18 Participant Base Premium
DO NOT ENTER IT WILL AUTO CALCULATE
EVENT TYPE - Rate is per participant (18 or more). Includes any non motorized paddling vessel up to 48'*

RACING EVENT CLASS I-II $5.50RACING EVENT CLASS III $6.10RACING EVENT CLASS III-IV (primarily class III with sections of class IV) $6.70NON RACING CRUISING/PLEASURE PADDLING/SYMPOSIUMS - $5.20WORKSHOP/CANOE-KAYAK CAMPING/ PADDLE TRAINING CAMP/PADDLE DAY CAMP - $5.20BIATHLON - $7.80TRIATHLON - $9.60ERGOMETER - INDOOR & OUTDOOR - $3.45
# PARTICIPANTS - (18 or more)*
More than 18 Participant Base Premium
WILL AUTO CALCULATE
All Biathlons and Triathlons must include 1 leg of paddling: Indicate other legs other*

RunBikeSwimOther
Describe Run, Bike or Swim leg location and safety measures for each leg:*
Will you be using Golf carts or ATV's? If yes we will contact you to complete a separate supplement -*

YesNo
PRM Membership - Check one.*

$25 Annually (Non Refundable)Paid with a previous event in 2025Paid with 2025 Club Liability
DO YOU NEED TO ADD ADDITIONAL INSUREDS - $20 per entity.*

YES- $20 PerNO
# Additional Insureds*
Enter number of entities
Additional Ins total
Please Note:

The Waiver of Subrogation Endorsement and the Primary Non-Contributory Endorsement are no longer issued as separate endorsements. These have be added to the policy terms and conditions on a blanket basis. You will receive a certificate of insurance with the endorsement number and a copy of the policy form.

If any entity needs specific wording on the certificate please type into the comments box. Alternatively you can email or upload a copy of the document or permitting agreement with the wording or requirements. Paddlesports@jacka-liquori.com

If you have not been asked to provide endorsements check "additional insured certificate" box only.
DO NOT CHECK ANY OTHER ENDORSEMENT BOXES IF YOU HAVE NOT BEEN ASKED TO PROVIDE THEM BY THE ENTITY. You will be provided an additional insured certificate*

Additional Insured Certificate - Check this if no endorsements are requiredWaiver of Subrogation (blanket endorsement)30 days Notice of cancellationCG 20-26 Designated Person/OrganizationCD20-12 State or Government AgencyPrimary Non-Contributory (blanket endorsement)Other
If more than 6 are needed please use the Additional Request form on our website. DO NOT EMAIL US. A form must be submitted. Certificates will not longer be issued by email request. If an address is not entered the certificate will not be issued.
1) Additional Insured
2) Additional Insured
3) Additional Insured
4) Additional Insured
5) Additional Insured
6) Additional Insured
Digial Waiver:

A digital waiver system is available for event organizers to access. Your organization/club name and/or logo can be added to the waiver. We recommend using a generic email address for the signed waiver notifications to go to to avoid clogging up personal email.

If you have multiple events during the year you will be able to use the same system we will add the new event once scheduled. You will not be required to mail or email copies of club waivers as our office will download from the database.

You will be given a link for the waiver. The link can be placed on your registration website, social media page or emailed to registrants. Access to a back office to view and download all signed waivers will be provided.
Select Waiver You Will Use (you may select a combination of PDF and E-waiver)*

PDF-PaperPRM Electronic Waiver System - Renewal of previous year - $35PRM E Waiver System - NEW $35Current PRM E-Waiver user - (paid renewal with prior 2025 event)Using Alternative Electronic Waiver System
Please provide an email address for signed waiver notifications assignment if selecting the PRM Waiver System:
We recommend creating a generic email address to avoid your personal email being swamped with notifications
If you would like us to add your logo please upload a copy of logo. If you have previously provided it we will have it on file.

(jpg, jpeg, tif, gif, png, pdf formats)
Cancelof
EXPRESS PROCESSING - Only check IF SUBMITTING LESS than 5 days prior to event. IF YOU HAVE NOT RECEIVED YOUR DOCUMENTS THE DAY BEFORE YOUR EVENT PLEASE CALL OUR OFFICE.

$20 - Non Refundable
TOTAL DUE - WILL AUTO CALCULATE
WILL AUTO CALCULATE
Please indicate payment method*

Mail - Application will not be processed until payment is received. Your check will be processed electronically.Online (check, credit/debit) - After clicking the submit button you will be directed to payment page - (No vendor fees for payment by check. Vendor fees apply to credit/debit card)
MAILING ADDRESS:

Make check payable to: Paddlesport Risk Management, LLC

PO Box 668

Kings Park, NY 11754

(631) 321-6859 with any questions

Email: paddlesports@jacka-liquori.com
Submission of this application confirms our desire to obtain insurance as a member of Paddlesport Risk Management, LLC under its special event liabilty program.

I hereby certify that this event will be held in accordance with the requirements of Paddlesport Risk Management, LLC (PRM); U.S. Coast Guard requirements or state laws, whichever is stricter. I further acknowledge that a safety briefing for all participants will be held prior to the event start.

Each participant will sign an approved release of liability waiver. Multi signature waivers are not acceptable. Waivers must be submitted to PRM within 14 days after the event with the post event form.
Signature

Clear
Date*

MonthDayYear
Date
COMMENTS
LEAVE A COMMENT, ANY SPECIAL REQUESTS OR SUGGESTIONS TO HELP US IMPROVE OUR SERVICES
If you have any questions at all please call our office.

(631) 269-321-6859 or email us at paddlesports@jacka-liquori.com
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2025 SPECIAL EVENT APPLICATION