Please add each of your race events to be covered (additional activities can be added in the field(s) below).
Note: If you need to change the dates below at any time, please contact us; you may not be covered otherwise
Please include the following for each additional event needing coverage - Event Name, Event Location, Event Organizer (individual or entity to be covered), First Day of Event (include set up dates), Last Day of Event (include dismantlement dates), Estimated Total Number of Participants (do not include your volunteers or staff members - these individuals are covered under the group accident and general liability policies.
Additional Activities to be covered
Please enter additional activities you would like to cover. If any of these activities are scheduled outside of the event dates listed above, please adjust the coverage dates below.
Please check all that apply
The coverage period should include the dates of all of your races and additional activities
Does your event include any of the following activities: Open Road Cycling, Use of ATV's, Bungee Jumping, Fire Dancing/Walking, Firearms/Riflery, Gymnastics, Inflatable Devices, Zip Lines, Mechanical Bulls, Motor Sports, Rappelling, Rock Climbing, Ropes Courses, Scuba Diving, Trampolines, White Water Rafting, All? *
If yes, please provide an explanation below:
Please add any additional insureds that are required below
Running USA, 954 Dana Lane, Waukesha, WI 53189
Running USA is automatically added as an Additional Insured to all policies
To add Additional Insureds, please include the following for EACH Additional Insureds - Legal Name, First Name, Last Name, Address, City, State, Zip Code, Email, Relationship to the Insured (Venue, Municipality, Contractor, etc.) and any required certificate verbiage.
Please list each Additional Insured that requires the Primary and Non-Contributory Endorsement below.
Please provide details or type "NO" below
PLEASE READ AND SIGN (By typing your name) BELOW:
Please note: this event insurance application is subject to full underwriting. The decision to provide a quote or not is, in part, determined by the answers you have provided in the above application. Should a policy be issued, it will include certain exclusions and limitations. It is the applicant/insured's responsibility to read and understand the terms in any policy that is issued and bound. Not all insurance products are available in all states. Please contact the Nicholas Hill Group, Inc. by emailing email@example.com with any product questions. All insurance products are provided by licensed representatives.
Agent Signature: Ryan E. Hill
Agency: Nicholas Hill Group, Inc.