PURCHASE TEAM INSURANCE – STEP ONE

Please read the following disclosure of the Insurance Terms and Conditions.

You must acknowledge your understanding of them by checking the Checkboxes and clicking the Accept button at the bottom of this page.

 

TEAM INSURANCE PROPOSAL

Application Fee Per Team – $25.00

Additional Charges for Insurance:
Team Insurance for Age Groups 12 & Under – $65.00
Team Insurance for Age Groups 13-15 – $90.00
Team Insurance for Age Groups 16-18 – $115.00

GENERAL LIABILITY COVERAGE

Insurer – An A+ Rated Liability Insurance Company
$1,000,000: Each Occurrence Limit
$5,000,000: General Aggregate Limit (other than Products-Completed Operations)
$1,000,000: Products Completed Operations Aggregate Limit
$5,000: Medical Expense Limit (excludes athletic participants)
$1,000,000: Legal Liability to Participants per Occurrence
$1,000,000: Professional Liability per Wrongful Act
$1,000,000: Hired & Non-Owned Automobile Coverage (Not provided while in Hawaii)
$1,000,000: Damage to Premises Rented to You
$1,000,000: Personal & Advertising Injury

ACCIDENT MEDICAL COVERAGE

Insurer – An A+ Rated Liability Insurance Company
$25,000: Medical Payments for Participants – Excess, per Participant
$250: Deductible per Claim

CONDITIONS

  • Premium is fully earned at inception of policy.
  • Coverage includes coaches, officials, participants, clubs, and anyone acting in a volunteer capacity on behalf of the team.
  • Insurance applies only to the specified activities selected on the application that are sponsored and directly supervised by the named insured.
  • Coverage applies only to the sport selected and for which a premium has been paid.
  • Sexual abuse and molestation coverage is excluded.
  • Signed waivers must be retained in order for participant liablility to apply.
    • A waiver and release form is required to be signed by all coaches, volunteers, parents of minor players, and players aged 18 years old. Coverage is contingent upon having procedures in place that require the signing of the release and waiver of liability by all of the aforementioned parties. Participant Liability Coverage will not apply if this is not in place.
  • Team names may not be changed once coverage is bound.

 

MANDATORY FRAUD WARNING STATEMENTS BY STATE

Applicable in AL, AR, DC, LA, MD, NM, RI and WV:
“Any person who knowingly (or willfully)* presents a false or fraudulent claim for payment of a loss or benefit or knowingly (or willfully)* presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. *Applies in MD Only.”

Applicable in CO:
“It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.”

Applicable in FL and OK:
“Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony (of the third degree)*. *Applies in FL Only.”

Applicable in KS:
“Any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written, electronic, electronic impulse, facsimile, magnetic, oral, or telephonic communication or statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act.”

Applicable in KY, NY, OH and PA:
“Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties* (not to exceed five thousand dollars and the stated value of the claim for each such violation)*. *Applies in NY Only.”

Applicable in ME, TN, VA and WA:
Insurance applications must contain this statement:
“Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.”

Applicable in ME, TN, VA and WA:
“It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties (may)* include imprisonment, fines and denial of insurance benefits. *Applies in ME Only.”

Applicable in NJ:
“Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.”

Applicable in OR:
“Any person who knowingly and with intent to defraud or solicit another to defraud the insurer by submitting an application containing a false statement as to any material fact may be violating state law.”

 

ACCEPTANCE

 There will be no more than 15 players registered per team. Teams with more than 15 players will be registered as multiple teams (one team per group of 15 players).

 This team has not had any liability or accident claims in the last five (5) years. If there has been a claim, please email info@esportsinsurance.com for personalized service.

 I understand coverage is contingent upon obtaining a parent/guardian signature on the provided Release/Waiver form for every player.

 I understand that the insurance company, in determining whether to provide insurance coverage, will rely on the information contained in this form and all other information being submitted. I hereby warrant, represent and confirm that, to the best of my knowledge, all information provided is complete, true and correct.

 I am aware that the insurance company expects accurate reporting for my premium calculation. I understand that my books and records my be examined or audited by the insurance company at any time during the coverage period and up to three years thereafter. Intentional misrepresentation or misreporting may jeopardize coverage. I further acknowledge that I have reviewed all information provided with this enrollment form and understand the exclusions which apply, as well as the activities and operations for which coverage is not provided.

 I have read all of the preceding and by checking the check boxes, pressing the Accept button and completing the payment process, acknowledge that I understand the coverage and conditions and I accept them as stated and wish to bind coverage. I understand that the premium and membership fee are fully earned and non-refundable.

If there are circumstances or situations that prevent you from checking all of these items, please email info@esportsinsurance.com for personalized service. It is highly probable that we can still provide insurance with additional information.

Ready to Play Ball?