Purchase Program Insurance | Junior Volleyball Association

"*" indicates required fields

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? Contact Lisa Wielebnicki lisa.wielebnicki@jvavolleyball.org

Indoor: $110/team

Beach: $10/player

*Covers all PLAYERS, COACHES, and TRYOUTS

Contact Information

Name*

First Last

Phone*

Email*

Your Club*

Your club must be a JVA Member in order to purchase JVA Insurance.

Program 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.

Yes

Parent Organization*

If different from the Club Name, please enter in the name of the business.

Season Start Date including Tryouts*

Club Director Name*

First Last

Club Director Email*

Club Director Phone*

Total Number of Locations*

Please enter a number greater than or equal to 1.

List All of Your Facilities with their Location and Contact*

Add rows to match the number of locations listed in the field above.

Name of Facility

Address

Contact Name

Contact Phone

Additional Certificates or Endorsements:

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.

Additional Certificate Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

List all Team Names Associated with this Program Insurance*

ex. 16 blue, 14-2, etc. This will help event directors identify which teams they do not have to cover at their tournaments. Click the "+" on the right to add more line items.

Purchase

Program Insurance Type*

Indoor: $110.00/Team

Beach: $10.00/Player

Number of Indoor Teams*