This Coach Liability policy will cover you for your activities as a Coach for
Interscholastic Equestrian Association Activities only . This policy does not cover you
as an employee of the Interscholastic Equestrian Association OR for any Non-IEA lessons where
you have a private training agreement. IEA is the named insured on this policy. Each coach is
added as an additional insured with Liability Limits of $1,000,000 per occurrence/$1,000,000
aggregate. Period of Coverage shall commence upon acceptance of a completed application and valid
premium payment and shall expire 6/30/2024.
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FRAUD WARNING NOTICES
STANDARD : Any person, who knowingly and with intent to defraud any insurance company or
other person, files an applications for insurance or statement of claim containing any materially false information
or conceals, for the purpose of misleading, information concerning any fact material hereto, commits a fraudulent act,
which is a crime, and may subject such person to criminal and civil penalties.
NOTICE TO ARKANSAS APPLICANTS : Any person who knowingly presents a false or fraudulent claim for payment
of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be
subject to fines and confinement in prison.
NOTICE TO COLORADO APPLICANTS : 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 DISTRICT OF COLUMBIA APPLICANTS :
Warning: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person.
Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a
claim was provided by the applicant.
NOTICE TO FLORIDA APPLICANTS : Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a
statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
NOTICE TO KENTUCKY APPLICANTS :
Any person who knowingly, and with intent to defraud any insurance company or other person files an application for insurance 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.
NOTICE TO LOUISIANA APPLICANTS :
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application
for insurance is guilty of a crime and may be subject to fines and confinement in prison.
NOTICE TO MAINE APPLICANTS : 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 MINNESOTA APPLICANTS : A person who submits an application or files a claim with intent to defraud or helps commit a fraud against
an insurer is guilty of a crime.
NOTICE TO NEW JERSEY APPLICANTS : 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 NEW MEXICO APPLICANTS : Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit
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.
The insurer shall not offer an optional extension period for this policy in New Mexico.
NOTICE TO OHIO APPLICANTS : Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits
an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
NOTICE TO OKLAHOMA APPLICANTS : Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for
the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
NOTICE TO OREGON APPLICANTS : 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 may be guilty of insurance fraud which may subject such person to criminal and civil penalties, including but not limited to fines, denial of insurance
benefits, civil damages, criminal prosecution and confinement in state prisons.
NOTICE TO PENNSYLVANIA APPLICANTS : 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 TENNESSEE, VIRGINIA AND WASHINGTON APPLICANTS : 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 NEW YORK APPLICANTS : Any person who knowingly and with intent to defraud any insurance company or any 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 ($5,000) and the stated
value of the claim for each such violation.
THE UNDERSIGNED IS AUTHORIZED BY THE INSURED AND DECLARES THAT THE STATEMENTS SET FORTH HEREIN AND ALL WRITTEN STATEMENTS AND MATERIALS FURNISHED TO THE INSURER
IN CONJUNCTION WITH THIS APPLICATION ARE TRUE. SIGNING OF THIS APPLICATION DOES NOT BIND THE INSURED OR THE INSURER TO COMPLETE THE INSURANCE, BUT IT IS AGREED THAT
THE STATEMENTS CONTAINED IN THIS APPLICATION, ANY SUPPLEMENTAL APPLICATIONS, AND THE MATERIALS SUBMITTED HEREWITH ARE THE BASIS OF THE CONTRACT SHOULD A POLICY BE
ISSUED AND HAVE BEEN RELIED UPON BY THE INSURER IN ISSUING ANY POLICY.
THE APPLICATION AND MATERIALS SUBMITTED WITH IT SHALL BE RETAINED ON FILE WITH THE INSURER AND SHALL BE DEEMED ATTACHED TO AND BECOME PART OF THE POLICY IF ISSUED.
THE INSURER IS AUTHORIZED TO MAKE ANY INVESTIGATION AND INQUIRY IN CONNECTION WITH THIS APPLICATION AS IT DEEMS NECESSARY. PROVIDED, HOWEVER, THIS PARAGRAPH DOES
NOT APPLY IN THE STATES OF UTAH AND WISCONSIN.
NOTE TO UTAH AND WISCONSIN RESIDENTS: ALL WRITTEN STATEMENTS AND MATERIALS FURNISHED TO THE INSURER IN CONJUNCTION WITH THIS APPLICATION ARE MADE A PART HEREOF
PROVIDED THIS APPLICATION AND SUCH MATERIALS ARE ATTACHED TO THE POLICY AT THE TIME OF ITS DELIVERY.
THE INSURED AGREES THAT IF THE INFORMATION SUPPLIED ON THIS APPLICATION CHANGES BETWEEN THE DATE OF THIS APPLICATION AND THE EFFECTIVE DATE OF THE INSURANCE,
THE INSURED WILL, IN ORDER FOR THE INFORMATION TO BE ACCURATE ON THE EFFECTIVE DATE OF THE INSURANCE, IMMEDIATELY NOTIFY THE INSURER OF SUCH CHANGES, AND THE
INSURER MAY WITHDRAW OR MODIFY ANY OUTSTANDING QUOTATIONS OR AUTHORIZATIONS OR AGREEMENTS TO BIND THE INSURANCE.
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I acknowledge and agree that by clicking to initial the boxes in this agreement I am providing an electronic signature
as defined by the Global and National Commerce Act and the Uniform Electronic Transaction Act. I affirm that I am authorized
to sign this document on behalf of the minor participant and I acknowledge that an electronic signature is treated the same as
a written signature for all legal intents and purposes.
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