INJURY FORMS
Medical Claim Form & Instructions - filed by parents
INSURANCE FACILITY & EVENT FORMS
IA Facility Insurance Request Form
Rental Agreement Checklist
CLUB & TEAM INSURANCE FORMS
USAV D&O Liability Program Summary
To renew or purchase coverage, please complete the online application process per the instructions below:
- Click on the following link: https://v3.sportsportal.epicbrokers.com/purchase/usavolleyball
- The system will prompt you to login or create a new user account. If you have registered as a user previously within the old website, please select “Yes” and input your login information into the corresponding fields. If you have not registered as a user previously within the old website, please select “No” and input your user information into the corresponding fields. Once completed, select “Authenticate User.”
- The system will then prompt you input your club’s information and club contact information regardless of if you are a new or returning user. Input your club’s details into the corresponding fields and select “Next.”
- Select the desired limit option by clicking on the button corresponding to the desired limit (The annual premium is $525 for a $1,000,000 limit; $825 for a $2,000,000 limit) and then select “Next.”
- Complete the online application for your organization and select “Next” once completed.
Note: In order to qualify for this program, your organization must meet the following eligibility requirements: must be a not-for-profit with annual revenues less than $1,000,000, have no more than 5 paid employees, and not have any pending/prior D&O or EPL claims. If your organization does not meet these eligibility requirements, please contact our office for assistance.
- If your organization is deemed eligible for the program based on your application answers, the system will prompt you to input your billing information and payment details.
- If your organization’s address matches your payment method’s billing address, please select the button that corresponds to this answer. Your organization’s address will then pre-populate into the billing information fields. If your organization’s address does NOT match your payment method’s billing address, please input your billing information into the corresponding fields.
- If you are using a credit card as your payment method, input your credit card details within the Billing Method section. If you are using ACH instead, please select the switch button located within the Billing Method section, and the ACH fields will populate. Submit your payment via VISA, MasterCard, or ACH only.
- There is a purchase fee / payment processing fee associated with your payment method. This fee and your purchase total will be noted in the Order Summary section at the bottom of the page. Once you have reviewed the information, select “Submit Payment.”
- Please note, the system may take several minutes to process. Do NOT refresh or cancel your transaction. If you are worried that your transaction did not go through, please contact sports@epicbrokers.com
- Once your transaction goes through, the system will prompt you to a confirmation screen where you are able to download/print your certificate of insurance directly (as proof of insurance coverage). Additionally, you will be sent a confirmation email complete with your receipt and your certificate attached from the email address sportportal@epicbrokers.com
Junior Medical Release Form for Iowa
INSURANCE SUMMARIES
Summary of Insurance Program
Secondary Sport Accident Ins. Summary
