CABA Colorado Insurance Program

Policyholder Information


Fields marked with an asterisk (*) are required.

Team Name
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Note: This is the name that will appear on your Certificate of Insurance. If your company is a Sole Proprietorship, then this will be your personal name or DBA.

Contact Information
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Mailing Address
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Coverage Information


Fields marked with an asterisk (*) are required.

The coverage will expire 12/31 of each calendar year.
In order to purchase coverage for the entire year, please select 1/1 as Effective Date

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Covered Activity:
Coverage is provided for participation in scheduled and supervised games, practices, try-outs, tournament events (all tournament organization’s events – not only CABA Colorado events), meetings, award banquets, approved fundraisers, and group travel as a member of an insured team during the policy term.
Accident Medical Coverage:
$100,000.00
$10,000.00
$250.00
General Liability Coverage:
$3,000,000.00
$1,000,000.00
$5,000.00

Underwriting Information


Fields marked with an asterisk (*) are required.

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Each Team must install a Release and Waiver of Liability and Indemnity Agreement for all participants and staff. Unintentional error on your part in securing Waiver and Release forms shall not void your coverage in the event of an occurrence to a participant or staff. However, your failure to maintain an adequate system to regularly secure Waiver and Release forms shall void your coverage in the event of an occurrence to a participant or staff. A full supply of Waiver and Release forms shall be shipped to you upon request.

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Additional Insureds


Name Address Relationship Cost
Caba Colorado
6657 S. Ottawa, A11 Littleton CO 80128 Tournament association
Add Additional Insured
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Payment Information


Fields marked with an asterisk (*) are required.

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Signature

Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud and may be subject to civil fines and criminal punishment. Minimum premium is fully earned upon inception and not refundable in the event of cancellation.

I certify that the information provided in this application is correct in its entirety, to the best of my knowledge.

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