Comprehensive Rodeo Liability
Application Form


Type of Policy.........................

Comprehensive Rodeo Liability



Rodeo Committee
(Not applicable if Stock Contractor Only)


Named Insured........................


Street Address........................


City, State Zip.........................

,

Phone Number........................


Fax Number............................


Contact...................................


Contact e-Mail.........................


Certificate Required?................

Yes No



Stock Contractor

Name of Stock Contractor(s)....


Street Address........................


City, State Zip.........................

,

Phone Number........................


Fax Number............................


Contact...................................


Contact e-Mail.........................


Certificate Required?................

Yes No



Additional Insureds
(Not applicable if Stock Contractor Only)


1) Name of Additional Insured.......


Street Address........................


City, State Zip.........................

,

Phone Number........................


Fax Number............................


Type.......................................

Landowner Sponsor Other

Certificate Required?................

Yes No



2) Name of Additional Insured.......


Street Address........................


City, State Zip.........................

,

Phone Number........................


Fax Number............................


Type.......................................

Landowner Sponsor Other

Certificate Required?................

Yes No



General Information

Name of Rodeo Association.......

PRCA NHSRA PBR
IPRA NLBRA CCPRA
NIRA WPRA PWBR
Other

Name of Rodeo .........................


Name of Rodeo Premises..........


Street Address.......................


City, State Zip........................

,

Name of Holding Pens................
(if different from Rodeo Premises)......


Street Address.......................


City, State Zip........................

,

......Date Insured(s) will assume........ control of premises........

/ /20

Performance Dates.................

From: / /20 To: / /20
Total Performances:
Average Estimated Attendance per Performance

Slack Dates...........................




Activities OTHER THAN Rodeo Performances
Please call for premium quotation.

1) None

2)
Premium:
Date: _-_
Location:

3)
Premium:
Date: _-_
Location:

4)
Premium:
Date: _-_
Location:

5)
Premium:
Date: _-_
Location:

6)
Premium:
Date: _-_
Location:
7) Are you having a fireworks display? (Not covered under basic rodeo policy) Yes No
8) Are you having amusement rides in conjunction with the rodeo? (Not covered under basic rodeo policy) Yes No
9) Do you sell alcoholic beverages? (Not covered under basic rodeo policy) Yes No
Coverage Plans Available
Coverage may be obtained by one of two plans depending on the circumstances at a particular rodeo.
The coverage options are:
These rates are not applicable for those residing in:
CA, FL, HI, LA, MO, MT, ND, NE, NH, OH, SD, WA, & WV
Click Here for Rates in states shown above
Adult Rodeo
Youth Rodeo
College, High School & Youth
Spectator Liability Full Rodeo Rates*
Spectator Liability Full Rodeo Rates
Limit of Liability
Rate per Performance
Limit of Liability
Rate per Performance
$500,000
$1,000,000 Aggregate*
$519
$500,000
$1,000,000 Aggregate*
$223
$1,000,000
$2,000,000 Aggregate*
$805
$1,000,000
$2,000,000 Aggregate*
$347
* Call for rates for performances over 3000 average attendance
Stock Contractor Only Rates
Stock Contractor Only Rates
Limit of Liability
Rate per Performance
Limit of Liability
Rate per Performance
$500,000
$1,000,000 Aggregate*
$237
$500,000
$1,000,000 Aggregate*
$141
$1,000,000
$2,000,000 Aggregate*
$394
$1,000,000
$2,000,000 Aggregate*
$219
* Aggregate per Event
Please See Note 1
Rating Information
Limit of Liability Insurance Requested.......... $500,000 $1,000,000
(Higher Limits Available - Call for quotation)
____
Type of insurance requested
____
Rate per performance
____
Premium (Rate x Number of Performances)
Stock Contractor's Liability Only $
    $
Full Rodeo Liability $
    $
Activities other than Rodeo Performances
Premium total (if any) from previous section.
    $
TOTAL PREMIUM:
    $
    (May be subject to minimum policy premium.)
Participant Liability is available under certain circumstances Arena Personnel Coverage is available under certain circumstances
Note 1: Coverage is available for Certified Acts of Terrorism as provided by the Terrorism Risk Insurance Act of 2002.    Click Here For Rates and Disclosure
Comments:
 
Payment MUST ACCOMPANY this request form. Mailing envelope MUST REFLECT POSTMARK PRIOR to the Effective Date of Coverage. For payment options click here.
Name of requesting party: ___
Position:
Date:
___
THIS FORM WILL BE SUBMITTED ELECTRONICALLY TO SPI.

Please also submit your cashiers check or money order to:
SPECIALTY PROGRAM INSURORS, INC. 4300 Shawnee Mission Parkway, Shawnee Mission, KS 66205
____________________________________P.O. Box 2946 Shawnee Mission, KS 66201-1346


PAYMENT MUST BE RECEIVED PRIOR TO COVERAGE EFFECTIVE DATE