Event Liability Application

To access this Special Event/Festival insurance program your club/organization MUST be a member of one of the USDBF affiliates - ERDBA, ADBA, PDBA OR SRDBA

If you are not a member or need to renew your membership please click the applicable affiliate link above to complete the 2025 membership process BEFORE you complete this application.

IF YOU APPLY FOR COVERAGE AND ARE NOT A MEMBER OF ONE OF THE REGIONAL AFFILIATES ABOVE YOUR COVERAGE WILL BE CANCELLED AND NO PREMIUM WILL BE REFUNDED. COVERAGE CAN BE REINSTATED ONCE YOU PROVIDE PROOF OF A REGIONAL MEMBERSHIP.

What Affiliate is your club/organization a member of?*

EVENT NAME:*

EVENT HOST/ORGANIZER*

EVENT DATE*

MULTI-DAY EVENT END DATE

MULTI-DAY EVENTS MUST BE CONSECUTIVE

PRE EVENT PRACTICE START DATE

Insert start date

LOCATION and BODY OF WATER WHERE EVENT WILL TAKE PLACE*

PLEASE ENTER BODY OF WATER, TOWN AND STATE

Describe Safety Measures at Event*

eg. EMTs, Police, Coast Guard, First Aid onsite...

INSURANCE CONTACT NAME*

First NameLast Name

CONTACT MAILING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

CONTACT EMAIL - All insurance documents will be emailed to this address*

example@example.com

CONTACT PHONE NUMBER *

Area CodePhone Number

USDBF SAFETY ADDENDUM - PLEASE READ

Check below to confirm that the USDBF Safety Addendum has been read and the terms and conditions will be adhered to*

Acceptance of this proposal confirms your desire to obtain insurance through the Sports, Liesure, & Entertainment Risk Purchasing Group.

I hereby certify that safety requirements of the United States Dragon Boat Federation have been met and the rules and regulations of the US Coast Guard or state law, 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 an approved release of liability waiver.

I understand that copies of waivers MUST be returned to the USDBF Insurance Administrators office within 14 days post event via mail, downloaded to a flashdrive and mailed or emailed. If using a vendor provided waiver please download the waivers to a zipfile and email to Paddlesports@jacka-liquori.com

Signature*

First NameLast Name

PREMIUM CALCULATION

If you have an event with 10 and 20 paddler teams each team will be calculated separately regardless if some paddlers are paddling in both classes.

You will be required to submit waivers and post event accounting. If you have overpaid the number of teams you will be refunded. If you underestimated the number of teams the balance will be due with in 14 days post event.

20 PADDLER EVENT: Check the number of teams registered

1-25 Teams - $108 Per Team26- 50 Teams - $88 Per Team51 + Teams - $62 Per Team

Enter # Teams - 20 Paddler Teams

20 Paddler Premium

10 PADDLER TEAMS: Check the number of teams registered

1-25 Teams - $54 Per Team26- 50 Teams - $44 Per Team51 + Teams - $31 Per Team

Enter # Teams - 10 Paddler Teams

10 Paddler Premium

Program Administration Fee - MANDATORY*

$100 (Non Refundable)

Will you be using any of the following off road vehicles? If YES - You will be sent a separate form to complete.*

GOLF CARTSATV'sNONEOther

DO YOU NEED TO ADD ADDITIONAL INSUREDS - $25 Per entity*

YESNO

If you have more than 10 additional insureds please enter 10 into the box below and attach a list of names and address' using the upload button or email a list to Paddlesports@jacka-liquori.com

# Additional Insureds*

Enter number of entities

Additional Insured Premium

You will be provided an additional insured certificate. If the entity requires specific endorsements please upload or email a copy of the permit insurance requirements. DO NOT REQUEST ENDORSEMENTS IF YOU ARE NOT ASKED BY THE ENTITY TO PROVIDE IT. Ensure that the name and address is current. Not checking will create delays waiting for changes to be made.

Additional Insured Certificate of insuranceWaiver of Subrogation30 days Notice of cancellationPrimary Non Contributory EndorsementCG 2026 - Designated Person/OrganizationCG 2012 Contracted Owners/Government EntitiesSpecial wording - type special wording in comments box below indicating which entity requires it.Other

Name and Address' of Additional Insureds (Please type each on separate line)

If you have a state, municipality or government document or description of requirements please upload a copy

Upload Files

DIGITAL WAIVERS:

An digital waiver system is available for clubs to access. Your club name and/or logo will be added to the waiver. It is recommended to provide a generic email address for notifications of a signed waiver to go to. The cost per year for data storage is $35. You will not be required to mail or email copies of waivers as our office will download at the end of the season.

You will be given a link to post to your website/social media or to email to participants in addition to a QR code with a link to the waiver. You will have access to a back office where you will see all signed waivers and be able to download.

SELECT TYPE OF WAIVER YOU WILL USE*

PDF - Paper waiverE WAIVER SYSTEM NEW SETUP - $35E WAIVER SYSTEM - RENEWING 2025 - $35USING ALTERNATIVE VENDOR REGISTRATION/E WAIVER

If you would like your organizations logo added to a PDF or E-Waiver please upload file if you have provided it previously we will have it on file. If you need to update your logo please attach.

Browse Files

(jpg, jpeg, tif, gif, png formats)

EXPRESS PROCESSING - check if submitting less than 5 days prior to event

$20 - Non Refundable

TOTAL DUE - WILL AUTO CALCULATE

SELECT PAYMENT METHOD: Please note: if mailing, your application will not be processed until the premium is received.*

ONLINE - Check or Credit Card (No Vendor fees for check payment. Vendor processing fees apply to credit/debit card payment)MAILING (application will be processed once payment has been received)

COMMENT

LEAVE A COMMENT OR SUGGESTION TO HELP US IMPROVE OUR SERVICES

Make check payable to: Paddlesport Risk Management, LLC

Please reference name of event on your check.

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

If you have questions contact Maria Liquori

Phone(631) 321-6859; Email: Paddlesports@jacka-liquori.com

2025 DRAGON BOAT RACING AND FESTIVAL APPLICATION