Professional Underwater Liability Insurance Application

* Desired Effective Date:
New    Renew
 
* Association #:
 
* First Name: Initial:
* Last Name:
 
* Address 1:
  Address 2:
* City:
  State/Province:
  Zip Code:
* Country:
 
* Home Phone: Work Phone:
 
 
  FAX:
* E-mail:
 

Section 1 - Professional Liability Insurance - Base Premium

Select category based on the desired coverage limit. Insurance costs include premium, fees and applicable State taxes. All costs are in US funds and are fully earned - there are no refunds. Higher limits are available by individual quotation - contact Peter Meyer or Barb Beauchemin

Limit per Occurence $1,000,000 $2,000,000 $3,000,000
Instructor $260.00 US $442.00 US $520.00 US
 
Divemaster $185.00 US $315.00 US $370.00 US
 
Sustaining Instructor $185.00 US $315.00 US $370.00 US
 
Assistant Instructor $185.00 US $315.00 US $370.00 US
 
Teaching Assistant $185.00 US $315.00 US $370.00 US
 
 

Section 2 - Optional Coverage

Select Optional Coverage(s) required:

Technical Training/Supervision
(you must be "tech" certified for this coverage to apply)
Your policy can be extended to provide coverage for qualified individuals conducting activities that exceed normal SDI/TDI/ERDI parameters.

Choose Tech A OR Tech B Option NOT Both
Technical Endorsement A | 33.00
Adds coverage for Training / Supervision deeper than 130 feet / 40 metres and for gas mixes other than Air or Nitrox (I.E. Tri-mix).

Technical Endorsement B | 65.00
Adds Tech Endorsement A plus coverage for Training / Supervision with rebreathers (SCCR and / or CCR).

Equipment Liability | 225.00
Your policy can be extended to provide liability coverage for equipment failure. This coverage extension applies only to equipment owned by the insured and used in the insured's classes under his/her supervision.