Sports Insurance solutions

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1 Sports Insurance solutions Name of club: To be completed and returned to your Division Manager by no later than 28 February 2015.

2 Sports Insurance solutions Queensland Rugby League 2015 Insurance Declaration Arthur J. Gallagher Co (Aus) Limited Level 2, 601 Coronation Drive Toowong QLD 4066 GPO Box 1113 Brisbane QLD 4001 T: 1800 SPORT 5 ( ) F: (07) Attention: Committee Members QRL Affiliated Clubs and Local Leagues Dear Committee Members, Re: 2015 QRL Statewide Insurance Program It is compulsory that each Affiliated Club and Local League (where applicable) effects for its Teams, the minimum level of Insurance cover by 28 February The level of benefits provided by the Program are not comprehensive and as such the QRL and Arthur J. Gallagher encourage all participants to take out Private Health, Life and Income Protection Insurance according to their own individual circumstances. It must be clearly understood that after being informed of the level of cover taken out by a Club or Local League, it is an Individual s responsibility to ensure that he / she has adequate Insurance cover for his / her needs. It is essential that each Club and Local League Executive advise all Players, Officials and Volunteers associated with its Teams of this level of Insurance cover and any additional cover it has taken out. To assist in advising all participants of their minimum insurance cover we have produced a Quick Guide to the 2015 QRL Insurance Program that must be distributed to all participants by Clubs and Local Leagues (where applicable). Your 2014 cover will expire at 4pm on 31 December Arthur J. Gallagher will arrange for the minimum 2015 cover to take effect from 4pm 31 December 2014 for all Affiliated QRL Clubs and Local Leagues. You must complete this Insurance Program Declaration and return to your Division Manager by 28 February 2015 together with your premium payment / loan agreement and a copy of any contractual agreements entered into by the organisation. Yours sincerely Endorsed by Terry Berryman Account Executive Arthur J. Gallagher Rob Moore Chief Executive Officer QLD Rugby League Arthur J. Gallagher. Sport

3 Important Dates and Information 4pm 31 December 2014 to 4pm 28 February 2015 Training and participating in trial / non fixture games sanctioned by QRL: Cover provided to those Players / Coaches who: Were registered with a QRL Affiliated Club / Local League for the 2014 season; or Are registered with a QRL Affiliated Club / Local League for the 2015 season; or Have listed on a trial and train register with a QRL Affiliated Club / Local League for the 2015 season. 4pm 28 February 2015 to 4pm 1 October 2015 No cover whatsoever unless Players / Coaches: Are registered with a QRL Affiliated Club / Local League for the 2015 season; and The Club / Local League has submitted its completed Insurance Program Declaration together with its payment / loan agreement to its Division Manager. 4pm 1 October 2015 to 4pm 31 December 2015 Participating in fixture games sanctioned by QRL: Cover provided to those Players / Coaches who: Were registered with a QRL Affiliated Club / Local League for the 2015 season. Training and participating in trial / non fixture games sanctioned by QRL: Cover provided to those Players / Coaches who: Were registered with a QRL Affiliated Club / Local League for the 2015 season; or Are registered with a QRL Affiliated Club / Local League for the 2014 season; or Have been listed on a trial and train register with a QRL Affiliated Club / Local League for the 2014 season. Important Information Please Note: A person who has reached the age of forty (40) years or is reaching that age during a football season, and desires to participate in a game of rugby league under these Rules, must lodge with his Player s Agreement each year a Certificate or Report issued by a Registered Sports Physician or Medical Specialist in Queensland stating that the person does not have any apparent impediment, declared or otherwise, that would preclude his participation in a body contact sport. Please also note that the Public Liability and Player Accident insurance covers under the QRL Insurance Program which covers your club for all Rugby League activities does not extend to include One Off Rugby League Carnivals or other ancillary sports such as Touch Football competitions. Arthur J. Gallagher has developed a policy specifically for One Off Rugby League Carnivals and other ancillary sports such as Touch Football competitions, which will protect your club for any incidents relating to these activities. Please note major Policy Exclusions on pages 18 and 19 of the QRL Handbook. QRL 2015 Insurance Declaration Page 3

4 Club Details General Details Full name of the Club (as per Incorporation Certificate) QRL Club ID #: Are you registered for GST purposes? Yes No What is your ABN? Postal Address of Club Club Grounds Address Postcode Postcode Club President Treasurer Secretary Name Telephone (B/Hrs) Fax Mobile Has your Club applied for affiliation for the 2015 season and been accepted by the relevant Division? Yes No Division (Please circle) South East Central Northern League Club Activities Does your Club hold a liquor license, outside QRL game day? Yes No If Yes, what are your trading hours? Does your Club have poker machines? Yes No If Yes, how many? What is your Club s annual turnover? $ (i.e. revenue prior to expenses) Does your Club operate another sport Yes No If Yes, what type Previous Public Liability Claims Yes No If Yes, please attach details Childminding / Playground Yes No Public Gymnasium Yes No Live Entertainment (Bands etc) Yes No Dance Floor Yes No After 1.00am Trading Yes No Provide Outside Catering Yes No Closed Circuit TV Monitoring installed Yes No Arthur J. Gallagher. Sport

5 Property Insurance Renewal/Quote Request Declaration Property Sums Insured Material Damage Buildings $ Contents $ Stock $ Lighting & Towers $ Other $ Description Other $ Description Mobile Machinery (Tractors / Ride on Mowers etc) $ Description Registered Mobile Machine $ Yes No Mobile Machine $ Yes No Machinery Breakdown (Pumps, Motors & Compressors) Description Required $ Description Required Limit any one loss $25,000 Yes No Deterioration of stock $2,500 Yes No Electronic Equipment & Breakdown (Computers, Hardware & Software) $ Description Required Limit any one loss $5,000 Yes No Data Restoration $2,500 Yes No Increased cost of working $2,500 Yes No Business Interruption Gross Profit $ Payroll (if insured separately) $ Other Insurances Does your Club take out any additional insurance cover than that provided via QRL / Arthur J. Gallagher? Yes No If yes, please provide details below Type of Policy Due Date Insurer Broker QRL 2015 Insurance Declaration Page 5

6 Sports Insurance solutions Queensland Rugby League 2015 Insurance Declaration Cost per Team PART A Grade Number of Teams Stamp Duty Exempt (**Exemption Required) Not Stamp Duty Exempt Under $ 90 or $ 97 = $ Premium Under $130 or $137 = $ Under $130 or $137 = $ Under $190 or $200 = $ Under $190 or $200 = $ Under $270 or $285 = $ Under $270 or $285 = $ Under $450 or $470 = $ Under $450 or $470 = $ Under $670 or $692 = $ Under $770 or $801 = $ Under $870 or $902 = $ Under $960 or $992 = $ Total Part A $ ** To qualify for the Stamp Duty Exempt Premium, you must provide a copy of your Stamp Duty Exemption Certificate each year. If you do not provide this certificate, the Stamp Duty Exempt premium, will not be accepted. Arthur J. Gallagher. Sport

7 Cost per Team PART B Grade Number of Teams Stamp Duty Exempt (**Exemption Required) Not Stamp Duty Exempt Under $2,035 or $2,080 = $ Premium Under $2,990 or $3,065 = $ Under $2,990 or $3,065 = $ A $2,990 or $3,065 = $ B $2,990 or $3,065 = $ C $2,990 or $3,065 = $ $2,990 or $3,065 = $ $2,990 or $3,065 = $ $2,990 or $3,065 = $ Intrust Super $2,990 or $3,065 = $ FOGS $2,990 or $3,065 = $ FOGS $2,990 or $3,065 = $ Total Part B $ Cost per Team Part C Category Stamp Duty Exempt (**Exemption Required) Not Stamp Duty Exempt Club Management Liability $335 $350 Senior Teams Loss of Income (refer page 7/8 of 2015 Insurance Program Handbook) $ Premium $335 or $350 (please circle) Individual Player Loss of Income Weekly Benefit Premium Player Name: $ Player Name: $ Player Name: $ Total Part C $ Total Premium Payable $ ** To qualify for the Stamp Duty Exempt Premium, you must provide a copy of your Stamp Duty Exemption Certificate each year. If you do not provide this certificate, the Stamp Duty Exempt premium, will not be accepted. To obtain certificate you must contact the Office of State Revenue. Details can be found at: QRL 2015 Insurance Declaration Page 7

8 Sports Insurance solutions Queensland Rugby League 2015 Insurance Declaration Duty of Disclosure Before you enter into a contract of general insurance with an Insurer, you have a duty at law to disclose to the Insurer anything that you could be reasonably expected to know is relevant to the Insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a contract of general insurance. Your duty however does not require disclosure of matter: that diminishes the risk to be undertaken by the insurer; that is of common knowledge; that your insurer knows or, in the ordinary course of business ought to know; as to which compliance with your duty is waived by the insurer. If you fail to comply with your duty of disclosure, the Insurer may be entitled to reduce its liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the Insurer may also have the option of avoiding the contract from its beginning. Declaration & Acknowledgements I/We declare and acknowledge that I/We: have not suppressed, misrepresented or misstated any material information within my knowledge likely to affect the Insurers decision as to my eligibility for insurance and the answers given in the Proposal and the completed quote questionnaire are in every respect true and correct. have received, read and fully understand the details contained in the 2015 QRL Insurance Program Handbook. Furthermore, I acknowledge the property insurance program is an optional policy and that cover will only commence upon written acceptance of a formal quotation provided by Arthur J. Gallagher. acknowledge that the public liability insurance component of the insurance program is intended to provide cover for normal activities of Rugby League. Activities outside of Rugby League including but not limited to fundraising and social activities may not be covered under this policy and should be referred to Arthur J. Gallagher for clarification. subject to the Insurance (Agents and Brokers) Act, if this Proposal is accepted by the Insurer, the Proposal, the Policy and Schedule issued shall constitute the entire agreement between you and us, and shall supersede any prior representations or warranties. Signature of Secretary or President Name of Secretary or President Date / / Arthur J. Gallagher. Sport

9 Important Checklist General Has the Duty of Disclosure been signed and dated? Yes No Have you attached copies of all contractual Agreements signed by the Club / Local League? Yes No If you are claiming Stamp Duty Exempt status have you attached a copy of your certificate from the Office of State Revenue? Yes No Payment Options (tick) 1. Cheque for $ made payable to Arthur J. Gallagher is attached 2. Premium Funding if you wish to Fund please contact Arthur J. Gallagher on 1800 SPORT 0 to obtain a Funding quote NOTE: If you would like a funding quotation for monthly instalments please follow these steps: 1. Phone 1800 SPORT 0 ( ) and advise that you are a QRL Club requesting a Premium Funding Quotation. 2. Have your total team numbers ready. 3. A quote & contract will then be ed to you 4. If you accept the funding contract, simply complete, sign and return directly to your Division Manager, together with your completed 2015 QRL Insurance Program Declaration. REMINDER: Completed documents must be forwarded to your Division Manager by no later than the 28 February Please return the completed Declaration together with your Payment / Loan Agreement to the Division Manager of your relevant QRL Division. QRL 2015 Insurance Declaration Page 9

10 Sports Insurance solutions Queensland Rugby League 2015 Insurance Declaration Contacts Arthur J. Gallagher Branch Sport, Leisure and Recreation team Level 2, 601 Coronation Drive, TOOWONG QLD 4066 Postal Address: GPO Box 1113 BRISBANE QLD 4001 Phone: 1800 SPORT 0 ( ) Fax: Account Executive Terry Berryman Phone: (07) Mobile: terry.berryman@ajg.com.au Assistant Account Executive Julian Jemmott Phone: (07) julian.jemmott@ajg.com.au Arthur J. Gallagher. Sport

11 Contacts QRL QRL South East Queensland Division Postal Address: PO Box 1000, RED HILL QLD 4059 Division Manager: Michael Pease Phone: Fax: Ipswich Office: Gold Coast Office: Phone: Phone: Fax: Fax: QRL Central Division Postal Address: PO Box 3429, VILLAGE FAIR TOOWOOMBA QLD 4350 Division Manager: Glenn Ottaway Phone: Fax: Maryborough Office: Phone: Fax: QRL Northern Division Postal Address: PO Box 547, TOWNSVILLE QLD 4810 Division Manager: Scott Nosworthy Phone: Fax: QRL 2015 Insurance Declaration Page 11

12 Arthur J. Gallagher Insurance Brokers. AFSL To the extent that any material in this brochure may be considered advice, it may only be considered general advice as it does not take into account your personal objectives, needs or financial situation. Arthur J. Gallagher urges you to read the relevant policy wording and consider whether any products are appropriate for your situation before making a decision to acquire insurance. Ref 0843-Nov SPORT 0 ( )