Individuals and outside organizations may hold events at facilities provided they:
To get an online premium quote and apply for coverage, simply click the Apply Now button to the right. If you have questions or need more information, click any of the tabs above or contact Mercer at 1-866-838- 9536.
Please note, the Certificate of Insurance for which you are applying may be subject to additional approval requirements by the underwriting Insurance Company. Please be sure to submit your application at least 7 to 10 days prior to the event date in order to meet your organization’s event insurance needs. Submission of a completed application and/or premium payment is not a guarantee of coverage. Coverage is not in place for your event until Certificate of Insurance is provided.
During the renewal process and website update, you may not be able to access the online registration. If you need to obtain a Certificate of Insurance during this time, a manual application (pdf) can be emailed to our team at: email@example.com
Prior to the event you must deliver a Certificate of Insurance to the facility in charge of the space. The Certificate should be accompanied by a note listing the name of the event sponsor, the date of the event, and the location of the event (since some departments control multiple venues).
If you already have insurance coverage, please have your insurance company send the facility in charge of the space a Certificate of Insurance with the following specifications:
If you DO NOT have insurance coverage of your own, you may obtain coverage by filling out the online or paper (pdf) application provided on this website. Payment must be received prior to the event. A Certificate of Insurance will be issued upon receipt of payment. The Certificate of Insurance is your proof of coverage. Present it to the facility in charge of the space prior to the event.
****Failure to comply with one, or both, of the following requirements will affect Participant Legal Liability in place for any event even if a Certificate of Insurance is provided.****
For sports participants, you must have Accident Medical coverage in force. Failure to purchase Accident Medical insurance will mean that Participants Legal Liability will be subject to a $10,000 deductible. To apply for Accident Medical coverage, please click on the Accident Medical Application Form button below. We partner with Special Markets Insurance Consultants (SMIC) to provide this coverage.
You must also have a Waiver and Release form system that is regularly maintained or Participants Legal Liability will be subject to a $10,000 deductible. This system must secure and maintain properly executed Waiver and Release forms for all participants. For minor participants (under eighteen years of age) you must always secure and maintain properly executed Minor Waiver and Release forms signed by the parent or legal guardian.
Participants Legal Liability provides coverage for claims you are legally obligated to pay because of actions brought against you, the Named Insured, by players and/or other participant(s). Participant means any player, coach, manager, staff member, team worker, official, media personnel, cheerleader, or band member practicing for, or participating in, the sporting event. This means all of your team members and players and any participating non members! Participant liability insurance, like all liability policies, would provide coverage to the injured party only if the tenant user were liable.
When reporting a notice of loss (injury, property damage to third parties, auto accidents, etc.; related to a registered event), please provide as much detail as possible. This should include, but not be limited to, Insured Name (The Regents of the University of California plus student organization/club name), Contact Name (student organization/club), Policy Number, Claimant Name, Claimant Contact Information, Date of Loss, Location of Loss, Cause of Loss, Your Policy or Reference Number, Initial Steps Taken to Mitigate the Loss, Type (s) and Description of Damage and Estimated Amount of Loss.
The claims customer service department will immediately process your first notice of loss and you will be contacted by your servicing representative.
For information on how to report a University of California Accident Medical claim, please see below. You must report the accident claim to SMIC prior to reporting a liability claim to Philadelphia.
Special Markets Insurance Consultants, Inc.
Phone: 800-727-7642 ext. 6112
Phone: (866) 838-9536 (8:00 a.m. to 5:00 p.m. Central, M-F)
FAX: (515) 365-3005
Mercer Health & Benefits Insurance Services LLC
PO Box 14521
Des Moines, IA 50306
12421 Meredith Drive
Urbandale, IA 50323
Special Markets Insurance Consultants, Inc.
1265 Main Street, Suite 202
Stevens Point, WI 54481
firstname.lastname@example.org with a copy to email@example.com
To apply for coverage, simply click the Apply Now button below or you can download a form.
TULIP Application Form
UC Hazard Class Chart
Accident Medical Application Form – Sports Teams/Leagues
Accident Medical Application Form – Clubs/Groups
Contact Mercer at 866-838-9536 from 8 a.m. to
5 p.m. (Central) if questions. One note:
your representative may refer to TULIP coverage.
Don’t worry. TULIP stands for Tenant User’s Liability Insurance
Policy, and it is what you are applying for.