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Home My WebLink AboutO.U.R. Swing Dance Insurance Policy PDF.pdfPROPOSAL NUMBER 2144924 PREPARED ON 07/12/2021 PRICING VALID UNTIL 07/19/2021 (7 da ys ) Event General Liability I nsurance P roposal & A pplication All P remiums have been paid! PREPARED FOR Ga vin Ha rtle y 220 S 2n d We s t, Re xburg, ID 83440 P ho ne : 2 0 8 3 5 0 1 279 Ema il: ha rtle y_ga vin @ ya ho o .co m LIC ENSED AGENT Fie ld -Wa ld o Ins ura nce Age ncie s , In c . On ta rio , OR 97914 P h o n e : 5 4 1 8899181 Ema il: e ma rtin e z@ wa ldo a ge ncie s .co m PROPOSAL C REATED BY Fie ld-Wa ld o In s u ra nce Age ncie s , Inc . Onta rio , OR 9 7 9 14 P ho ne : 5 4 1 8 8 9 9 181 Ema il: e ma rtine z@ wa ld o a ge ncie s .co m INSURED BY E va n s to n In s ura nce Co mpa ny NAIC: 3 5 3 78 Ra tin g : A.M. BEST A(Exce lle nt) XV COVERAGE LIMITS Each Occur r ence (Includes Bodily Injur y and Pr oper ty Damage) $1,000,000 Damage to Rented Premis es $100,000 Per s onal & Adver tis ing Injury $1,000,000 Pr oducts / Com pleted Operations Aggr egate $1,000,000 G ener al Aggr egate $2,000,000 Medical Payments $5,000 Liquor Liability Not Included Waiver of S ubr ogation Not Included Pr imar y & Non-C ontributory Not Included Additional Ins ur ed(s )Included Hir ed & Non-O wned Auto Not Included Deductible $1,000 POLIC Y C OVERAGE INTENT T his is jus t an brie f ove rvie w , s e e po lic y for exa ct c o ve ra ge . Pr oper ty Damage Coverage for your r ented Event Locations . B odily Injur y Coverage for your Event Attendees . Pr otection fr om Property Damage & B odily Injury Laws uits . COST BREAKDOWN Pr emium $87.00 S tamping Fees $0.44 Tax $1.31 Policy Fee $37.22 Ris k P ur chas ing Group Member s hip Cos t $0.00 Am ount P aid $125.97 EVENT DETAILS Whe re is yo u r e ve nt?ID To ta l da ys o f c o ve ra ge yo u ne e d?1 Es tima te d to ta l a tte nda nce ?250 Ch a rity Da n ce UNDERWRITING QUESTIONS Se e Un d e rwriting Do cume nt COVERAGE TERM Da t e s o f C o ve ra ge : 07/17/2021 He mmin g Villa g e Ho ldings LLC He mmin g Villa g e IV LLC 160 W 2n d S o u th Re xburg , ID 8 3 4 40 ADDITIONAL INSUREDS (SHOWING 1 OF 1) Page 1 of 2 DocuSign Envelope ID: 7736EC33-083F-412F-B4B9-1BA928EC3A21 PROPOSAL NUMBER 2144924 PREPARED ON 07/12/2021 PRICING VALID UNTIL 07/19/2021 (7 da ys ) Event General Liability I nsurance P roposal & A pplication All P remiums have been paid! If I c ho o se t o c a nc e l my general liability po l i c y, I wi l l be subjec t to a refund fe e o f $37.22, t he ful l Administration C ha rge o n my po l i c y. In the very unlikel y c a se o ur po l i c y fo rm a nd c overage terms do no t me e t my ve nue 's insuranc e require me nt s a nd c a nno t be amended to do so , I a m e l i gi bl e fo r a full refund o f my po l i c y pri c e . No re funds wi l l be issued after the c o mme nc e me nt o f the polic y perio d. S e e ful l re fund po l ic y. Kim Speelman Agreed on July 12, 2021 at 11:56 AM I a gre e t o a nd unde rs tand the terms a nd c o ndi t i o ns o f my polic y(s). Kim Speelman Agreed on July 12, 2021 at 11:56 AM I c o nfi rm t ha t no ne o f the exc luded event t ype s o r se rvi c e s will be provided by t he i nsure d o n t hi s polic y. Kim Speelman Agreed on July 12, 2021 at 11:56 AM I unde rst a nd i nj uri e s to athletic /sporting pa rt i c i pa nt s, pe rformers/c rews and vo l unt e e rs wi l l no t be c overed by this po l i c y. Kim Speelman Agreed on July 12, 2021 at 11:56 AM I unde rst a nd t ha t t he re is no c overage fo r l o sse s due i n a ny way from c ommuni c a bl e di se a se i nc l uding C oronavirus di se a se (C OVID-19). Kim Speelman Agreed on July 12, 2021 at 11:56 AM NO T IC E T O T HE APPLIC ANT No fa c t , c i rc umst a nc e or situation indic a t i ng t he pro ba bi l i t y of a C laim or a c ti o n fo r whi c h c o ve rage may be affo rde d by t he pro po se d insuranc e is no w kno wn by a ny pe rso n(s) o r o rganiz ation(s) pro po se d fo r t hi s i nsura nc e other than tha t whi c h i s di sc l o se d in this applic atio n. It i s a gre e d by a l l c onc erned tha t i f t he re is kno wl e dge o f a ny s uc h fac t, c irc umsta nc e o r si t ua t i o n, a ny C laim subseque nt l y e ma na t i ng t he re from shall be exc l ude d fro m c o ve ra ge under the pro po se d insura nc e . F o r t he purpo se o f t hi s applic ation, I dec l a re t ha t t o t he be st of my knowledge a nd be l i e f, a ft e r reasonable inquiry, the st a t e me nt s i n t his applic ation a nd i n a ny a tta c hme nt s, a re t rue and c omplete. Unde rwri t i ng Ma na ge rs or the C ompany a re a ut ho ri z e d t o make any inquiry in c o nne c t i o n wi t h t his applic ation. S igni ng thi s a ppl i c a t i o n do e s not bind the C o mpa ny t o pro vi de o r t he Applic ant to purc ha se t he i nsura nc e. If the i nfo rma t i o n i n t his applic ation a nd a ny a t t a c hme nt materially c hanges be t we e n t he da t e t his applic ation is si gne d a nd t he e ffe c tive date of the po l i c y, I wi l l pro mpt l y no t i fy t h e underwriter, who ma y mo di fy o r wi t h draw any outsta ndi ng quo t a t i o n o r a greement to bind c o ve ra ge . INSURANC E F RAUD W ARNING Any pe rso n who kno wi ngly and with intent t o de fra ud a ny i nsuranc e c ompany o r a no t he r pe rso n fi les an applic atio n fo r i nsura nc e o r st atement of c laim c o nt a i ni ng a ny ma t e rially false informa ti o n, o r c o nc e a l s fo r the purpose of mi sl e a di ng i nfo rma t i o n c onc erning any fa c t ma t e ri a l t he re t o, c ommits a fra udul e nt insura nc e a c t , whi c h is a c rime in c erta i n j uri sdi c t i o ns, a nd subjec ts the perso n t o c ri mi na l a nd c ivil penalties. C l i c k he re fo r S TATE -S PEC IF IC F RAUD WARNING S TATEMENTS P l e a se re vi e w S AMP LE POLIC Y here T E RMS AND C O NDITIO NS A. I wa rra nt t o t he C o mpany, that I unde rst a nd a nd a c c e pt the notic e stated a bo ve a nd t ha t t he i nformation c onta i ne d he re i n i s t rue a nd that it shall be t he ba si s o f t he po l i c y a nd deemed inc orpo ra t e d t he re i n, sho ul d the C ompany evi de nc e i t s a c c e pt a n c e of this applic a ti o n by i ssua nc e o f a polic y. B . I c o nfi rm t ha t I understand that this po l i c y e xc l ude s c o verage for: any P erso n whi l e P ra c t i c i ng for or P artic ipating i n a De mo nst ra t i on, S how, C ompeti ti o n, C o nt e st o r At hl e t i c E vent; Animal Expo sure s; (c l a ssi fi e d a ni mal event remo ves a ni ma l e xc l usi o n) Assault & B attery; Aut o Expo sure s; C ommunic able Disea se s; C ybe r Ac t s, Inc i de nt s or Data B reac hes; Expl o si ve s; F i re a rms; Unmanned Airc ra ft C . I c o nfi rm t ha t t he re will be no Mosh P i t s o r F i re wo rks/P yrotec hnic s of any ki nd. D. I unde rst a nd t he re is no c overage fo r wa t e r a c t i vi t i e s, a musement devic es, i nfl a t a bl e s, ri de s o r animals (c lassifi e d a ni ma l e ve nt re moves animal exc l usi o n). Thi s do e s no t me a n I c annot have them a t my e ve nt , i t me a ns this polic y will e xc l ude c o ve ra ge for water ac tivities, a muse me nt de vi c e s, inflatables, rides o r a ni ma l s. Thi s po l i c y will not c over any a thl e t i c o r spo rt s pa rtic ipants, emplo ye e s, vo l unt e e rs, o r i ndividuals c ompensa t e d by t he i nsure d. E. I unde rst a nd t ha t t he event types unde r "EXC LU DED EVE NT TYPES " are exc l ude d fro m t hi s po l i c y. E XC LUDE D E VE NT TYPES Ai rc ra ft Eve nt s; B o a t S hows (on the o pen wa t e r); C a nna bi s Events or P roduc ts; C hi l dc a re ; C o nc e rts with Rap, Hip Ho p, He a vy Me t a l , o r Hard Roc k; F raterni t y P a rt i e s; Go Ka rt Ra c e s; Hang Gliding/S kyDi vi ng; Ha unt e d At trac tions; Haunted Ho use s; Ho t Ai r B a lloon Rides or Event s; Mo t o ri z e d S po rting Events; Music Eve nt s wi th Ove rni ght Expo s ure; Obstac le Rac es a nd Mud Runs; P a rac huting; P arasa i l i ng; P o l i t i c a l o r Ac t ivist Events inc ludi ng P ro t e st s, Ra l l i e s or Marc hes; Ra ve s; Ro l l e r C o a st e rs/S ky C oasters; Roller Derby; Ro l l e r S ka t i ng E vents; S kyDiving; S ka t e bo a rdi ng; S o rority Parties; Trac to r P ul l s; Tra mpo l i ne s; Unmanned Airc ra ft ; Wa l l C l i mbi ng; Wa r Ga mes/Re-enac tments; Wa t e r Eve nt s (un less c lassified as wa t e r e ve nt t ype ); Water S lides; Wea po n Eve nt s i nc l udi ng Gun S hows F . I a m he re by no t i fi e d that my polic y wi l l t e rmi na t e e ffe c t i ve no later than the da t e a nd t i me o f i ts expiration. I ha ve no ri ght o f a ut o matic renewal and a ddi t i o na l c o ve ra ge will require applic a ti o n wi t h no gua ra n tee of approval o r po l i c y i ssua nc e . I unde rst a nd t ha t by purc hasing this insura nc e I a m j o i ni ng the Promotion, Eve nt a nd P ri z e P urc hasing Group. C l i c k he re fo r S TATE -S PEC IF IC NOTIC ES Li c e nse d Age nt i n a l l 50 states: Will Ma ddux DocuSign Envelope ID: 7736EC33-083F-412F-B4B9-1BA928EC3A21 PROPOSAL NUMBER 2144924 ANSWERED ON 07/12/2021 POLICY EFFECTIVE 07/17/2021 Event General Liability I nsurance Underwriting A nswers No Ye s An s we r Da te : 07/12/2021 No Ye s An s we r Da te : 07/12/2021 No Ye s An s we r Da te : 07/12/2021 No Ye s An s we r Da te : 07/12/2021 No Ye s An s we r Da te : 07/12/2021 UNDERWRITING QUESTIONS & ANSWERS Question 1: Are there water activities, amusem ent devices, inflatables, rides or animals? Question 2: Will your event(s) be a political event, activist event, protest, rally or m arch? Question 3: Is there cam ping, sleeping overnight or events past 2am? Question 4: Have you or anyone involved in the Event had more than 1 Event Liability Claims/Losses or any Event Liability Claim /Loss valued over $10,000 in the past 5 years? Question 5: Will you, the insured, your operations, your products, or your event participation have any involvem ent with cannabis or cannabis-related products? DocuSign Envelope ID: 7736EC33-083F-412F-B4B9-1BA928EC3A21 7/12/2021