Certificate of Insurance (COI) Request Form

IMPORTANT | PLEASE READ
Please note: This is a group insurance policy. Unfortunately, you are not authorized to make changes to the policy unless Sport BC Insurance is provided consent from British Columbia Recreation and Parks Association (BCRPA).

This Certificate of Insurance (COI) request form has been shared by BCRPA and you must return it to an authorized BCRPA representative by completing and submitting this form. BCRPA will confirm your Fitness Leader Registration and distribute to Sport BC to issue the COI. Please refrain from contacting the Sport BC office directly with a COI request. If you do, your request will be forwarded to BCRPA.

We ask that you review the form for accuracy and compare it with your rental/user group agreement. Please fill it out to the best of your ability.

Since 2017 – COI's have not been sent out directly to the city/municipality/districts/villages due to frequent personnel changes/transitions with staff and contacts. After you receive the certificate of insurance from a representative, we kindly ask that you send this to your contact.

DETAILS OF THE INSURANCE POLICY
Date: February 1st, 2023
From: British Columbia Recreation & Parks Association
CGL Policy Limit $2,000,000.00 ($2M) or $5,000,000.00 ($5M)
Policy Term February 1, 2023 to February 1, 2024 @ 12:01AM

DESCRIPTION OF OPERATIONS -> The following activities are covered by this policy.
Older Adult Fitness, Aquatic Fitness, Group Fitness, Osteofit, Pilates Fitness, Weight Training, Yoga Fitness (excluding Bikram Yoga and Inversion), Fitness Theory*, and Personal Trainers. Practitioners shall include Supervisors of Fitness Leaders and Trainers of Fitness Leaders while they are performing Fitness Leader evaluations. *Fitness Leaders registered solely in Fitness Theory are insured for fitness instruction based upon the practical application of knowledge acquired in their specialty module course in a practicum setting for a period up to 365 days from the date of registration in Fitness Theory.

Including online and also at home instruction.

3. Named Insured/ Name of your organization

First Name *This question is required.

Last Name *This question is required.

Fitness Leader ID # *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone number *This question is required.

Business Name (if applicable)

4. Effective Date(s) & Time:

Start and end date of your policy *This question is required. This question requires a valid date format of MM/DD/YYYY.

Start Date calendar To: 02/01/2024 @ 12:01AM

5. Business of the Insureds/Activities (if applicable):
What activities are you requesting insurance for? Please list all. It must match or fit within the described description of operations previously noted.

LOCATION(S) OF THE ACTIVITIES

6. First location Information *This question is required.

List name and addresses of the location(s) your activities will take place. *This question is required.

Facility Name
Address (#)
Street Name
City
Postal Code

Is this also an additional insured? *This question is required.

7. Second location Information

List name and addresses of the location(s) your activities will take place.

Facility Name
Address (#)
Street Name
City
Postal Code

Is this also an additional insured?

8. Third location Information

List name and addresses of the location(s) your activities will take place.

Facility Name
Address (#)
Street Name
City
Postal Code

Is this also an additional insured?

9. Fourth location Information

List name and addresses of the location(s) your activities will take place.

Facility Name
Address (#)
Street Name
City
Postal Code

Is this also an additional insured?

ADDITIONAL INSUREDS
This should not be confused with additional named insureds. Additional insureds are facility owners (usually a city or municipality) and are leasing/renting a space to you to use.
Please name and list all additional insureds on this request form. Please put the full civic addresses. SBC Insurance will NOT be verifying the accuracy of this information as it is your responsibility as a policy holder to check and verify with the insurance requirements provided to you as a renter/user/facility user.

10. Please list the following information about your additional insured:

Facility Name or Owners Name
Address
Street Name
City
Postal Code
How the facility wants to be listed on the certificate

11. Please list the following information about your additional insured (2):

Facility Name or Owners Name
Address
Street Name
City
Postal Code
How the facility wants to be listed on certificate

12. Please list the following information about your additional insured (3):

Facility Name or Owner Name
Address
Street Name
City
Postal Code
How the facility wants to be listed on the certificate

13. Please list the following information about your additional insured (4):

Facility Name or Owner Name
Address
Street Name
City
Postal Code
How the facility wants to be listed on the certificate