Performance Rally Insurance Order Form

Performance Rally Insurance Order Form
Date of Application / Date de la demande: ___________________________________
Name of the Event / Nom du rallye: ________________________________________
Championship Status / Championnat: ______________________________________
Date(s) of the Event / Date(s) du rallye: ____________________________________
Location of the Event / Lieu du rallye: ______________________________________
Organizing Club / Club organisateur: ______________________________________
Number of Days / Nombre de jours: _______________________________________
Sponsors, property owners, etc, are automatically covered. If names are to be individually shown as
ADDITIONAL INSURED PARTIES please list below / Les commanditaires, les propriétaires terriens, etc., ont
automatiquement protégés. Si des noms doivent paraître de façon individuelle comme PARTIES ASSURÉES
ADDITIONNELLES, veuillez les inscrire ci-dessous :
Organizer contact information and whom Insurance Certificate should be sent to / Coordonnées de
l’organisateur à qui le Certificat d’assurance doit être envoyé :
Name / Nom: ____________________________________ Title / Titre :______________________________
Address / Adresse: _______________________________________________________________________
Email / Courriel:____________________________ Phone Home / Tél. (rés.): ________________________
Phone Business / Tél. (travail) : _________________________ Fax: ________________________
IMPORTANT
This order form and a set of event regs, and a completed underwriting package MUST be received by CARS
Thirty (30) days prior to your event. / Ce formulaire, le Règlement particulier du rallye et un dossier complet
des mesures de sécurité DOIT parvenir à CARS au moins 30 jours avant la tenue de votre rallye.
Canadian Association of Rallysport – Box 300, Turner Valley, AB, T0L 2A0 – 1 (855) 640-6444
carsrally.ca
Affiliated with ASN Canada FIA
CARS Performance Rally Underwriting Information
For each CARS Performance Rally, the following underwriting information MUST be submitted to CARS for
ASN Canada FIA. The underwriting information must be received thirty (30) days before the event and
include a set of event regs. All information can be sent to the cars office at [email protected].
What is needed:
1. COURSE DESCRIPTION:
A. Detailed maps of the roads to be utilized as stages during the rally, with starts and finishes marked,
are needed. Hand drawn maps are acceptable. An overall map showing transits, services and the
stages in relation to nearby centers is also required. Please highlight stages.
B. A map showing the roads & where the area is in relation to a city/town. This could be a copy of the
appropriate portion of a provincial road map.
C. Stage details (length, surface, speeds, history, etc)
D. Controls (number of personnel, locations)
E. General terrain and anticipated weather conditions.
F. Tentative schedule of the event including stage starts, stage finishes and services.
2. EVENT MANAGEMENT DESCRIPTION:
A. Individual names of event officials and their experience
B. Public notice procedures for road closures
C. Communications system
D. Course security procedures
3. SPECTATOR/PUBLIC VIEWING AREAS:
A. Description of spectator areas
B. Positive barrier protection or other protection and height of protective bank
C. Crowd control procedures
D. Spectator/public viewing area access and egress description
E. Detailed map of the areas involved (showing placement of barricades/road blockage, radios,
marshals, direction of rally traffic and [if any] spectator traffic and parking). Hand drawn maps are
acceptable.
4. EMERGENCY FACILITIES:
A. Medical attention (personnel, equipment, procedures)
B. Nearest hospital and transportation plans
This information must be submitted to CARS office
prior to confirmation of coverage being issued.
Please do not contact ASN Canada FIA directly.
Canadian Association of Rallysport – Box 300, Turner Valley, AB, T0L 2A0 – 1 (855) 640-6444
carsrally.ca
Affiliated with ASN Canada FIA