Alpine Ski/Snowboard School Pgm. insurance from SportsInsurance.com!

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Ski School/Insured information
Ski School Name
Director/Gen Mgr
Address
City
State
Country
Zip code
Phone number
Fax number
E-mail
Web Site

Years in operation with current owner/operator
Years in operation including other alpine schools


Contact information
Name
Address information same as above
Address
City
State/Province
Country
Zip/Postal code
Phone number
Fax number
E-mail

Agent/Broker information (if applicable)
Name
Phone number
Fax number
E-mail

Desired effective coverage dates:
From:	To

Approx. dates of ski school operation:
From:	To

Additional Named Insured
Ski Areas, the Forest Service and others sometimes request to be added to your liability insurance coverage as an Additional Insured.
Provide the full name and address of each. The company will issue certificates of Insurance for each and send them to you to be delivered to each of them as required.
N.B. Please email or fax us all Contracts and Permits you will or have signed that require you to assume any liability or hold others harmless and in which they request you have them added as Additional Insureds to your insurance coverages.

Name	Address	Role

Important
Notice to residents of Arizona: Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. Notice to residents of California: I understand that any false or misleading information on an application may be subject to criminal and civil penalties. California law prohibits an HIV test from being required or used by health insurance companies as a condition of obtaining health insurance coverage. Notice to residents of Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. Notice to residents of Maine: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits. Notice to residents of Michigan: Any person who knowingly and with intent to injure or defraud any insurer files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to one year for a misdemeanor conviction or up to ten years for a flony conviction and payment of a fine up to $5,000.00. Notice to residents of New Jersey: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Notice to residents of New Mexico: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benifit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties. Notice to residents of New York: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. Notice to residents of Ohio: Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or a deceptive statement is guilty of insurance fraud. Notice to residents of Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Notice to residents of Tennessee: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. Notice to residents of Virginia: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.
I acknowledge that I understand that any person who knowingly and with intent to defraud any insurance company commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. I hereby confirm that I have read and understand the above notice.

I Agree