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Welcome to JVA Insurance Enrollment

Following the completion of this registration, you will receive an email with IMPORTANT INSTRUCTIONS REGARDING JVA BACKGROUND SCREEN POLICY! *It is mandatory that ALL coaches and players complete the electronic insurance waiver.

QUESTIONS? Please contact: Lisa Wielebnicki lisa.wielebnicki@jvavolleyball.org

Indoor: $1/player/coach/day

Beach: $1/player/coach/day

*Covers players and coaches per day. If your program runs longer than 10 days, use the JVA Program insurance rates instead per every 10 kids.

Contact Information

Name*

Camps, Instructional, Tots, Mini, and Youth Insurance

Section 1 LIABILITY:

  • Carrier – International Insurance Company of Hannover
  • - Occurrence: $1,000,000
  • - Aggregate: $5,000,000
  • - Fire Damage: $100,000
  • - Products/Completed Operations: $1,000,000
  • - Personal/Advertising: $1,000,000
  • - Spectator Medical Expense: $5,000
  • - Physical/Sexual Abuse Option: $50,000/$100,000
  • --Non-Owned Auto Option – EXCLUDED (Can be added for separate premium upon approval)
  • --Sports Equipment Option – EXCLUDED (Can be added for separate premium upon approval)
  • Policy Term – Limited to Dates of League Play

Section 2 EXCESS ACCIDENT:

  • Carrier – AXIS Global Accident & Health
  • - Excess Accident Limit: $25,000
  • - AD&D: $2,500
  • - Deductible: $ 250
  • - Dental: $1,500
  • Policy Term – Limited to Dates of Season Any administrative fees added have been applied to the rates above.
Has there been any prior claim or incidents of alleged physical/sexual assault within your club?:**
Liability insurance includes Sexual Abuse & Molestation coverage. Please verify this statement.

Event Information

Camp Director(s)*
Please list all directors if more than one.
Only list those entities that contractually require you to name them as an additional insured on the policy. We will only honor such requests that are made by the league contact. Note that the certificates will not be sent directly to these entities – they will be sent to you for delivery. (If you do not provide the complete mailing address of the Additional insured(s) we will not be able to issue the certificate). Your insurance premium includes all additional insured (s) that are landowners, field locations or sponsors at policy inception. Special endorsements or specific certificate wording, as required by the additional insured, may incur an additional charge.
Please enter a number greater than or equal to 1.
List All of Your Tournament/League Locations with their Address and Contact*
Name of Facility
Address
Contact Name
Contact Phone
 

Insurance Purchase

Insurance Type (Camps, Instructional, Tots, Mini, and Youth)*
(Camp / Instructional / Tot / Mini / Youth)
Please enter a number greater than or equal to 1.
(Camp / Instructional / Tot / Mini / Youth)
Please enter a number greater than or equal to 1.
(Camp / Instructional / Tot / Mini / Youth)
Please enter a number greater than or equal to 1.
*Includes processing fee
List All Dates the Program Covers Individually*
Enter MM/DD/YYYY format
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