General Liability – Insurance Forms and Resources

Certificate of Insurance Request Form (Proof of Insurance)

When the other party has required a legal document be signed and wants proof of insurance, please send complete, legible copy of (any PERMIT, APPLICATION, CONTRACT AGREEMENT, LEASE or other) documents to our insurance Administrator so obligations can be determined. Please see the Diocesan insurance requirements and follow the step by step directions on COI Procedures

TULIP – K & K Event Insurance (Rental of church or school property for events)

Tenant Users Liability Insurance Policy, or TULIP, is an easy to use, fast method of insuring most types of events and activities taking place at various facilities and venues throughout the United States.

What is a TULIP Program?

The TULIP Program provides low cost general liability insurance to “third party” users of various venues and facilities for events. It protects both the user and the facility against claims by guests who may be injured as a result of attending an event.

Events may range from seminars, receptions and weddings, to sporting events and concerts. Your premium quote is based upon the risk associated with the given event or activity, the number of days coverage is needed, the number of attendees and if there are any special requirements, such as alcohol liability, food service, etc.

Category 1 Outside User Agreement (Rental of Church or School Property)

The Diocese has standard forms that must be completed when permission is given to others to use our premises.  This form is to be filled out by the parish administrator or pastor and returned to the Facilities, Risk and Insurance Department after purchasing the Tulip event insurance policy (as stated above).

Category 2 Outside User Agreement (Rental of Church or School Property)

All non-profit, religious, educational or charitable groups who would like to rent or use our facilities may do so using their organization’s insurance and by providing to us a certificate of insurance naming the Roman Catholic Bishop of San Jose as additional insured and meet our insurance requirements as stated on the Category 2 Organization/Outside User Agreement.  This form should be filled out by the administrator or pastor/principal and returned to the Facilities, Risk and Insurance Department along with the certificate of insurance at least two weeks prior to the event.

Carnival/Festival/Event Procedures

Carnival Addendum

Carnival companies and all vendors at the Carnival must provide evidence of insurance naming Diocese as ‘additional insured’.  Liquor License must be obtained if alcohol is made available.  Food Permit must be obtained if food is sold.  Coordinate early (45 days in advance) with the Facilities, Insurance and Risk Management.

Volunteer Management Guidelines

Volunteer Appendix

Volunteer Waiver (fillable)

Incident Report

Transportation Policy and Form

Student Activity Waiver

Student Accident Claim Form  Myers, Stevens & Toohey, Co., Inc.

A claim form must be filed for any student injured (while participating in a Diocesan approved activity) and taken for medical attention.  Section A is to be filled out by an administrator, pastor/principal and given to the child’s guardian.  The child’s guardian will submit the claim form and all (medical) out of pocket receipts to Myers, Stevens, Toohey, Co., Inc. for reimbursements. This insurance is secondary.

Field Trips Myers, Stevens & Toohey, Co., Inc.

Field trip insurance is required for day field trips and retreats.  Completed applications may be sent via email to activities@myers-stevens.com or Fax to 949.348.0963.

Overnight Retreats and Camp for Youth Myers, Stevens & Toohey, Co., Inc.

All parish and school groups planning an overnight trip involving youth (ages 1 to 17)  must purchase additional insurance for each child attending.  This secondary layer of insurance protects the family, the parish/school and the Dioceses.  Completed applications may be sent via email to activities@myers-stevens.com or Fax to 949.348.0963.

Events where participants engage in physical activity may require waiver and release forms.  Contact the Facilities, Insurance and Risk Department if you have any questions.

HIGH RISK ACTIVITIES

Every parish or school sponsored event creates a potential liability for the Diocese.  Before planning parish / school functions, we encourage you to balance the benefits anticipated with the unavoidable risks.  Some activities create such a great risk that they cannot be justified.  Sponsorship or involvement in the following activities are strictly prohibited :

•    Raft, Kayak, Canoe, watercraft or similar trips
•    Use of Parachutes
•    Inflatable Bouncing Houses/Games/Slides
•    Water/Snow Skiing
•    Wind/Water Surfing and Boogie Boarding
•    Parachute Sailing/Jumping
•    Climbing Walls
•    Motorcycles or all terrain vehicles
•    Any event involving Livestock
•    Boxing or Wrestling matches, Martial Arts, etc.
•    Dunk Tanks
•    Fire Performers, Firework Sales and Displays

•    Trampolines
•    Mountaineering and Rock Climbing
•    Use of Drones on Diocesan Property
•    Bungee Jumping
•    Skate Boarding, Ice and Roller Skating
•    Amusement Parks
•    Aircraft, including Hot Air Balloon rides.
•    Water Parks
•    Ropes or Adventure Courses more than 12 feet above the ground.

 

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1150 North First St. | San Jose, CA | 95112 | 408-983-0100