Event Liability Application

This coverage can be accessed by members of one of the following USDBF affiliates ERDBA, PDBA, ADBA or SRDBA.

If you are not a member and would like to apply for membership please click the applicable affiliate link above then come back to complete your application. We will confirm your membership before your application is processed. Attach a copy of your membership payment receipt in the upload links below if it was paid online.

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

ERDBA PDBA ADBA SRDBA

EVENT NAME: *

EVENT HOST/ORGANIZER *

EVENT DATE *

MULTI-DAY EVENT END DATE

MULTI-DAY EVENTS MUST BE CONSECUTIVE

PRE EVENT PRACTICE DATE/S

Insert start and end date

LOCATION OF EVENT *

CONTACT NAME *

First Name Last Name

CONTACT MAILING ADDRESS *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

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

Confirmation Email example@example.com

CONTACT PHONE NUMBER *

Area Code Phone Number

An approved USDBF participant liability waiver must be used. 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. If you have a waiver please upload a sample for pre-approval. If you will be using an electronic waiver system please check below.

Browse Files

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

Please check here if using an electronic waiver system

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 or emailed.

USDBF SAFETY ADDENDUM - PLEASE READ

Typing your name is acceptance of the terms and conditions of the USDBF Special Event Insurance Program and Safety Addendum.

First Name Last Name

Date Completed *

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 - $90 Per Team 26- 50 Teams - $70 Per Team 51 + Teams - $48 Per Team

Enter # Teams - 20 Paddler Teams

20 Paddler Premium

10 PADDLER TEAMS: Check the number of teams registered

1-25 Teams - $45 Per Team 26- 50 Teams - $35 Per Team 51 + Teams - $22 Per Team

Enter # Teams - 10 Paddler Teams

10 Paddler Premium

Program Administration Fee *

$115 (Non Refundable)

DO YOU NEED TO ADD ADDITIONAL INSUREDS $25 Per entity

Check if required Check if additional insured needs special wording and/or endorsements

# Additional Insureds *

Enter number of entities

What type of endorsements are required

Waiver of Subrogation 30 days Notice of cancellation Additional Insured Endorsement

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

Additional Insured Premium

EXPRESS PROCESSING - check if submitting less than 2 days prior to event

$20 - Non Refundable

TOTAL DUE - WILL AUTO CALCULATE

DO NOT CHANGE TOTALS

COMMENT

LEAVE A COMMENT OR SUGGESTION TO HELP US IMPROVE OUR SERVICES

Once you have completed all sections click the submit button and you will be transferred to make your payment by credit/debit or E-Check.

If you would like to mail your payment please check below Do not click the PayNow Button on the next screen.

Check if Mailing Premium - Your application will not be processed until premium is received in our office - No documents will be released.

Mailing

Make check payable to: Paddlesport Risk Management;

Mail To: 121 Pulaski Road, Kings Park, NY 11754

If you have questions contact Maria Liquori

Phone(631) 235-7959; Email: Paddlesports@jacka-liquori.com

2021 DRAGON BOAT RACING AND FESTIVAL APPLICATION