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Disclosure Notice Under the Financial Institutions Act
Province of British Columbia

The Financial Institutions Act requires that the information contained in this Disclosure Notice be provided to a customer in writing prior to the customer entering an insurance transaction.

Insurance Agent Disclosure:

Oasis Outdoor Adventure & Sport Insurance Solutions Inc. is licensed as a general insurance agent by the Insurance Council of British Columbia.

Insurance Company Name:

The insurance product or service being provided is underwritten by Lloyds of London.

Relationship between Licensed Agent and Insurance Company

Oasis Outdoor Adventure & Sport Insurance Solutions Inc has a contractual relationship with the Lloyd's of London to provide this product or service. There are no other financial or business relationships with Lloyd's of London.

Commission or Compensation

Upon completing this transaction, Oasis Outdoor Adventure & Sport Insurance Solutions Inc may be remunerated by way of commission and/or other remuneration from Lloyd's of London.

No Tied Selling

The Financial Institutions Act prohibits Lloyds of London or Oasis Outdoor Adventure & Sport Insurance Solutions Inc from requiring you to transact additional or other business as a condition of this transaction.

I have read the above terms and conditions and agree to proceed with the application.

DISCLOSURE NOTICE

Thank you for considering Oasis Outdoor Adventure & Sport Insurance Solutions Inc for your insurance needs. As part of our commitment to transparency and in compliance with the guidelines set out by the Registered Insurance Brokers of Ontario (RIBO), we are required to provide you with certain disclosures regarding your insurance transaction.

Please review the following important information:

Disclosure of Interest and Relationships

As a RIBO-licensed broker, we are committed to ensuring you are fully informed about any potential conflicts of interest or financial relationships that may affect your insurance purchase decision. Below are the details relevant to your insurance quote:

Ownership/Financial Interest Oasis Outdoor Adventure & Sport Insurance Solutions Inc does not have any financial interest/relationship with any of the insurance providers we represent.
Commission Structure: We receive commissions for placing business with insurance companies. This commission is based on the premium paid and may include other compensation, such as contingent commissions, depending on the overall performance of the policies we place. Below are the commission ranges for the insurance providers we work with:
- Certain Underwriters at Lloyds: 22.5% - 25%
- XN Financial (Certain Underwriters at Lloyds): 20% - 25%
- Travelers Insurance Company: 15% - 22.5%
- Unique Risks: 15%
- Special Risk Insurance Managers: 15%
- CFC Underwriting: 20%
- Premier Insurance Managers: 15%

Further Information

We are also required to provide you with additional documents for your reference:

CISRO Principles of Conduct for Insurance Intermediaries: This document outlines the principles guiding insurance intermediaries in their professional conduct.
Fact Sheet About Your Registered Insurance Broker: This fact sheet explains the role of your broker and what you should expect.

We value your trust and are committed to providing you with the best service. Should you have any questions or require further clarification regarding this disclosure or your insurance options, please do not hesitate to contact us at 1-866-979-2747 or send us an email at oasis@oasisins.ca.

I have read the above terms and conditions and agree to proceed with the application.

New - IMBA Club CGL Application

LIABILITY INSURANCE APPLICATION FOR BIKE CLUBS APPROVED BY THE INTERNATIONAL MOUNTAIN BIKE ASSOCIATION (IMBA CANADA)

Please answer all questions fully. If a question does not apply mark it as “N/A” If there is not enough room to answer in the space provided, please attach details. IMBA clubs must purchase and maintain an active IMBA membership. https://ccnbikes.com/#!/memberships/imba-canada-club-membership Waivers are required by members and for special event participants.

Brokerage (if applicable):

Brokerage Name or Contact:

Brokerage Email address:

Applicant's Legal Name:

Operating as:
Not-applicable
Mailing Address:

(Address)

(City)

(Province)

(Postal Code)

(Email Address)

(Secondary Email Address)

(Phone Number)

(Secondary Phone Number)

(Website)
Contact Person:

Title:
Is your Group a:

Mountain Bike GroupRoad Bike GroupOther

Incorporated Non ProfitIncorporated For ProfitInformal GroupOther
Revenues: Total operations gross revenues for all activities annually:

$

Annual Revenue From:

a) Membership dues:

b) Fund raising (describe):

c) Grants (describe):

d) Other (describe):
Years in Operation:
Years of Experience:
What is your Clubs estimated final Member numbers for this year?
Do you have any race, speed, or timed events or other larger special events or festival planning during the upcoming year (regular weekly rides are not deemed an event). YesNo

If yes list all events below. If they are more complex events please utilize the special events application. Click Here

List all Events (attach list if necessary):
1. Description
  
  Date
  
  Participants
  
  Spectators
2. Description
  
  Date
  
  Participants
  
  Spectators
3. Description
  
  Date
  
  Participants
  
  Spectators
4. Description
  
  Date
  
  Participants
  
  Spectators
5. Description
  
  Date
  
  Participants
  
  Spectators
6. Description
  
  Date
  
  Participants
  
  Spectators
7. Description
  
  Date
  
  Participants
  
  Spectators
8. Description
  
  Date
  
  Participants
  
  Spectators
9. Description
  
  Date
  
  Participants
  
  Spectators
10. Description
  
  Date
  
  Participants
  
  Spectators
11. Description
  
  Date
  
  Participants
  
  Spectators
12. Description
  
  Date
  
  Participants
  
  Spectators
Does your club have any activities that require a liquor license permit:
YesNo

Please be aware our policy has a liquor liability exclusion, if Liquor liability is required please use our liquor liability events link.
Liquor Liability Application Form
Does your club have winter fat biking:
YesNo
Does your club have winter activities requiring groomers for trail maintenance?
YesNo

(for liability puposes only. Coverage for the actual Groomer itself will be on a different application)

If yes, how many groomers and what type?
Does your club "own" any cabins, clubhouses, or storage sheds, C-Cans, shelters?
YesNo

(for liability puposes only. Coverage for the actual cabins, clubhouses, or storage sheds, C-Cans, shelters itself will be on a different application)

If yes, how many and what type, values?
Does your club own any equipment?
YesNo

(for liability puposes only. Coverage for the actual equipment itself will be on a different application)

(ex. tractors, self-propelled equipment, club bikes),
Do you have a Bike or Skills park?
YesNo

If so please complete a Bike Park application:
Click Here
Trails. Do you own, maintain, operate or sign any trails?
YesNo

If yes, how many kms:

Provide complete details of the trails including bridges, trestles, water crossings, level of difficulty and the extent of your responsibility:

Are they multi-use trails?
YesNo

If yes what other activities

Is there other Insurance in place on any of the above trails?
YesNo

If yes, how many kms:

What is the Limit of Liability:
(Copy of agreement or certificate of insurance may be required)

Who is responsible for maintenance, inspection and engineering?
Do you have man made trail "features" designed on your trails?
YesNo

If so, provide details of the types of features how many are involved. Photos or links that show the features very helpful (many liability incidents arise from features, they should be designed and with signage to IMBA standards).
Are there Gravity Mountain bike trails (ex. Mountain/Ski Hill descent trails)
YesNo

if yes please confirm what percentage of trails are gravity - example 50%
Does your club provide Cycling Valet Parking Services?
YesNo

If Yes request our bicycle valet parking supplement. (ex. if your club provides this service for events, festivals, farmers markets etc.)
List all activities of the club: (such as meetings, membership drives, trail activities, non-cycling activity etc.)
Previous Insurer:

Premium:
Loss History for the last five years:
If you are required to provide Certificates of Insurance please provide details:
Click Here
Have you ever had insurance cancelled or non-renewed for any reason?

Upload Supporting Documents:

Home, Condo & Tenants liability insurance automatically protects personal use cycling liability coverage and possibly some physical damage coverage for personal use bikes. Some club members may not have any of the above for their pedal bike's liability, accident benefits or physical damage. Your club should make members aware that they have options and access to the www.pedalpowerinsurance.ca website as it can reduce your club's exposures.

Membership waivers are required. Obtain waivers in a consistent reliable manner.

THIS IS AN APPLICATION ONLY AND DOES NOT CONSTITUTE OR IMPLY ANY INSURANCE COVERAGE IS IN FORCE.

Where (a) an Applicant for this contract gives false particulars to the prejudice of the insurer or knowingly misrepresents or fails to disclose any fact in any part of this application required to be stated therein; or (b) the insured contravenes a term of the contract or commits a fraud; or (c) the insured willfully makes a false statement in respect of a claim, a claim will become invalid and the Insured’s right to recovery is forfeited. The Applicants have reviewed contents of this application and acknowledge that all the information is true and correct and understand that this application for insurance is based on the truth and completeness of this information.

I have provided personal information in this document and otherwise and I may in the future provide further personal information. Some of this personal information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose any of this personal information, subject to the law and to my broker's or insurance company’s policy regarding personal information, for the purposes of communicating with me, assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I confirm that all individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf.

Applicant Signature:

Draw Upload file

(Name of Signer)

(Title or Position)

(Date)

By checking the box below you are certifying the information contained within this form to be accurate and correct.

I understand and agree

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