EVENT LIABILITY INSURANCE

"*" indicates required fields

1Chapter Information

2Insurance Form B

3Underwriting Information

4Trail Ride Information

5Review

Liability insurance coverage for your TLCA sanctioned event is available to all TLCA chapters in good standing. Requests should be submitted at least one month prior to the event.

Name of Chapter*

In order to be eligible for insurance your chapter must be in good standing.*

I confirm that my chapter is in good standing and we have submitted our chapter in good standing form for the current year

Event type*

For profit event

Not for profit event for a TLCA chapter

Do you require all event participants to have a TLCA membership?*

Yes

Event Committee Members*

Name of chapter member submitting this request*

Email of chapter member submitting this request*

Name of chapter member to receive invoice*

Email of chapter member who will receive invoice*

Name of Event*

Start Date of Event*

MM slash DD slash YYYY

End Date of Event*

MM slash DD slash YYYY

Event Location*

Name of site

Event Location Address*

Street Address City State ZIP Code

Type of Event*

Most events will be classified as a trail ride. If your event involves "wheels rolling" you should select trail ride.

Event Trail Ride

Rally or Swap Meet (non-moving event)

Other Event (trail clean up, etc.)

Name of person to receive insurance waivers*

First Last

Address of person to receive insurance waivers*

Street Address City State ZIP Code

Phone number of person receiving insurance waivers*

Email of person receiving insurance waivers*

Number of adult insurance waivers needed*

Number of child/minor insurance waivers needed*

NOTE: Competitions are not covered under our policy. You MUST disclose if there is a competition portion of your event which may make you ineligible for insurance and/or that your portion will be excluded from liability coverage. Misrepresentation of your event in any way will void your policy.

Does your event hold competitions?*

Competitions are timed events with wheels rolling such as rock crawling races, speed races, blind driver guided contests, etc. Competitions such as best chili, best looking truck, etc. do not apply.

Yes

Please explain your competition*

Agree*

I have read and understand that competitions are not covered under the TLCA policy and that I must disclose if there is a competition portion of our event.

If other, please explain*

How many total drivers/vehicles will register for your event?*

How many total participants (drivers/passengers/attendees) will register for your event?*

Miles*

Please list the estimated total miles of the event. For events that have multiple trail rides each day we understand this may be harder to provide an exact number so just provide a best estimate.

Coverages:*

Liability Limits

$1,000,000 CSL

Additional Insureds and relationship (landowner/sponsor)

Certificate of Insurance Required?*

Yes

Waiver and Release Requirement: Each event participant MUST sign the K&K Waiver and Release of Liability and Indemnity Agreement. The appropriate signed waiver must be forwarded to K&K upon request only, and is a condition of Participant Legal Liability Coverage.*

I have read and understand the waiver and release requirement

Event Location Diagram*

This question is required to be answered for our insurance carrier. If you are requesting for a trail ride select the first option and if you are requesting for an event with no wheels rolling select the second option.

Not for competition, trail ride activities only

Not for competition, swap meet or other activities only

Provide a detailed itinerary of ALL event activities (Incl. vendors, inflatables, music, etc.) taking place during the event*

A link to the itinerary on your website is also acceptable.

Vendor Notice*

Please note that all vendors are required to provide their own liability coverage and are not covered under this event insurance policy.

I have read and understand that all vendors are required to carry their own liability coverage for this event

Please provide the website and promotional flyers that will be used to advertise the event (if applicable)

If not applicable type n/a.

If the event will have any stops/locations that will be serving alcohol, please provide us with the controls that will be in place in regards to the alcohol consumption and ensuring that no participants will be drinking and driving during the “wheels moving” portion of the event. As well as the controls that will be in place to make sure that nobody that may have been overserved will be driving.*

If not applicable type n/a.

Document Upload

Required documents:
Copy of any pre-registration forms being secured (if any)
Copy of any contracts entered into (if any)
Copy of promotional flyers (if any)

Drop files here or

Accepted file types: jpg, png, pdf, doc, Max. file size: 128 MB.

Are control vehicles and/or spotters used for unusually rough terrain?*

Yes

Is a lead and/or tail vehicle used?*

Both lead and tail

Lead only

Is there some form of recognized communication between vehicles?*

Yes

What are you using for communication?*

Are fire extinguishers readily available?*

Yes

Will your event take participants on public roads?*

Yes

Valid personal auto insurance is required for all events that involve public roads. Please explain your plan for verifying participant insurance.*

Please confirm*

I confirm that our event does not take place on public roads

Has authorization been given for the event to take place on the specified property?*

Yes

Is Rock Crawling involved in any of the events?*

Rock Crawling is a competition based on completing courses in the best time similar to an Autocross in that there are cones set-up and hitting them adds time to your time/score.

Yes

If the vehicle is "open top" or "soft top," is a roll bar installed required for participants?*

Yes

Please provide the minimum age for vehicle operators? (16+ with valid drivers license required)*

Please provide the minimum age for passengers? If passengers under 18 are allowed, please provide the appropriate precautions in place for all minors (IE: Applicable safety restraints/car seats are required as per state laws)*

For remote events, what is the distance to the nearest town/medical facility?*

If not applicable type n/a.

If a vehicle becomes stuck, what are the towing procedures? (Winch? Cable or rope? Are participants cleared away until the vehicle is freed?)*

I hereby declare that the information provided is true and correct.*

Signature

Review your information. Use the 'previous' link at the bottom of this page to go back and make changes.
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