Special Events Liability Insurance Application

Application Form
General Business Information for Commercial General Liability

PLEASE READ THIS CAREFULLY BEFORE PROCEEDING WITH THE APPLICATION

I understand that completing and submitting this application does not result in insurance coverage. Coverage is not in effect until I have received written confirmation from OASIS.
I am aware that the information provided in this application must be correct, accurate and current. Incorrect information affecting the risk may result in a denial of insurance coverage at a later date.
I understand that there is a continuing obligation to immediately report to the insurer any changes that are material to the risk during the policy period.

Brokerage (if applicable):

Brokerage Name or Contact:

Brokerage Email address:

Name of Applicant/Names Insured:
Mailing Addresss:

(Address)

(City)

(Province)

(Postal Code)
Contact Name:

Phone:

Email:

Email #2:

Events Information
Please add all events for which you want to include insurance coverage.
Event 1:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 2:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 3:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 4:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 5:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 6:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 7:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 8:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 9:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Event 10:
1. Full Description of the Event. (Please upload diagram to the "Upload Supporting Documents" area near the end of this application form).
2. Location of Event: (Full Address):
3. Effective Date:
  Time:
  
  AMPM
  
  Expiry Date:
  Time:
  
  AMPM
4. Please Provide the following information about Daily Activities and Estimated Attendance including setup
  1. 1^st Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  2. 2^nd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  3. 3^rd Day
    
    Primary Activity
    
    Est. Attendance
    
    Other Activities
    
    Attendance
  Estimated Total Number of Attendees:
  
  What percentage of participants attending are minors (under 16)?
5. Who is providing food and/or drink: (Name)
6. If Products coverage is desired for food served for concession stands, please indicate kind of food served, by
7. If other than the Applicant, is a Certificate of Insurance provided?
  YesNo
  
  Name of Insurer
8. Will there be alcohol served at any of the activities?
  YesNo
  
  ** If yes, then please advise who obtains the permit and projected receipts**
9. If another party is responsible for alcohol, confirm there is a legal liability policy in force and certificate issued with the applicant named as additional insured.
10. Years in Operation:
11. Years of Experience:
12. What is your experience producing this type of event.
13. Revenues: Total operations gross revenues for all activities annually:
  
  $
14. Will any grandstands or bleachers be used?
  YesNo
  
  If yes, confirm: the construction
  
  Capacity:
  
  General Condition:
15. If a cycling event on trail please describe what level of difficulty are trails involved (Blue, Green or Black)?
  BlueGreenBlack
16. Describe safety measures, i.e., parking, traffic, security, supervision, first aid, evacuation.
17. General Comments
Has any company declined or cancelled any coverage?
YesNo

If yes, please provide details.
Previous Insurer:

Premium:
Limits Requested:
1 Million2 Million5 Million
Do you require Participant Accident Coverage?
YesNo

If Yes
Number of Participants:

Number of Support Staff:

Number of Officials:
Event Loss History

Upload Supporting Documents:

Please note that this is an application only. It does not constitute an insurance policy. Insurance shall become effective only on issuance of a policy or written binder specifically authorized by Outdoor Adventure & Sport Insurance Solutions Inc.
Quotations will be based upon the information provided which the applicant warrants is correct.

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

New - Special Events Liability Insurance Application

Application Form
General Business Information for Commercial General Liability

PLEASE READ THIS CAREFULLY BEFORE PROCEEDING WITH THE APPLICATION

Events Information

Event 1:

Event 2:

Event 3:

Event 4:

Event 5:

Event 6:

Event 7:

Event 8:

Event 9:

Event 10:

ABOUT OASIS Outdoor Adventure & Sport Insurance Solutions Inc.

CONTACT US

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Disclosure Notice Under the Financial Institutions ActProvince of British Columbia

DISCLOSURE NOTICE

New - Special Events Liability Insurance Application

Application Form General Business Information for Commercial General Liability

PLEASE READ THIS CAREFULLY BEFORE PROCEEDING WITH THE APPLICATION

Events Information

Event 1:

Event 2:

Event 3:

Event 4:

Event 5:

Event 6:

Event 7:

Event 8:

Event 9:

Event 10:

ABOUT OASIS Outdoor Adventure & Sport Insurance Solutions Inc.

CONTACT US

Disclosure Notice Under the Financial Institutions Act
Province of British Columbia

Application Form
General Business Information for Commercial General Liability