SODA Policy Change Request Form Please see complete the form below to request changes to current SODA policy. General Information Named Insured* (As it appears on your General Liability Policy) Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name* First Last Email* Phone* Effective Date Needed for Policy Change* MM slash DD slash YYYY Program Endorsement Requests Please select which of the following you wish to update on your current policy:* Adding additional teams/sports to my current policy Adding additional coverage(s) to current policy Increasing my limits of coverage on current policy Other Add Teams/Sports Please note: We can only add additional sports teams to your policy if they are in the same age category. The policy is rated per team/per sport. Please indicate age category (Youth or adult), Sport, and number of teams you need to add and the team names below :* Example: Youth Baseball - Add 3 Teams (Team 1 ABC, Team 2 123, Team 3 zxy), Youth Softball - Add 2 Teams (Team 1 SB ABC, Team 2 SB xyz) Additional Coverages Which additional coverage would you like to add to your current General Liability policy?* Non Owned and Hired Auto Liability Sexual Abuse & Molestation Coverage Other (D&O, Equipment, Crime) Click here to complete the other additional coverages Non-Owned and Hired Auto Liability Non-Owned Hired Auto Liability provides coverage if the insured organization is sued as a result of liability arising out of the use of an auto on insured organization business if such auto is not owned by the insured organization (ex: parent's auto, auto that is borrowed from a church or hired from a rental car company.) Coverage is excluded for 15 passenger vans. There is no coverage for the driver of any auto while transporting youth or adult participants. This policy does not cover physical damage to the non-owned or hired auto itself and, as a result, separate arrangements must be made for such coverage. I would like to add Non-Owned & Hired Auto Liability to our current GL Policy* Yes No Sexual Abuse & Molestation Coverage Coverage for sexual abuse and molestation will not apply unless the insured team or league implements the following requirements: 1. Have a system in place to perform and running criminal background checks on paid staff and volunteers 2. Have written procedures that include sexual abuse and molestation prevention 3. Have written procedures that include a response plan for allegations of sexual abuse or molestation including a requirement that law enforcement be contacted. Sadler provides a ready to adopt and implement template (both short form and regular) that will meet these requirements. Have you ever had a Sexual Abuse and Molestation Claim ?* Yes No If yes, please explain:* I would like to add Sexual Abuse & Molestation to our current General Liability Policy* Yes No Increase Limits of coverage: Please indicate and explain the limits of coverage you need to increase on your current SODA policy* Please describe other:*
