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2. Insurance Options (Select One)

4. Option

   1. Provide Own Insurance

5. Submit a Certificate of Liability Insurance with minimum coverage of $1 million personal liability. Certificate must list the following as Additional Insured:  • Town of Danville  • Attn: Recreation Services  • 500 La Gonda Way, Danville, CA 94526   If classes are held at Los Cerros or Diablo Vista Community Gymnasiums, or Monte Vista Community Pool, also include:  • San Ramon Valley Unified School District  • 699 Old Orchard Drive, Danville, CA 94526

9. Option

   1. Purchase Insurance Through Town

10. Insurance is available for purchase through the Town of Danville. Sports activities are not covered under this option.

    Insurance is non-refundable, even if classes are cancelled.

12. Season Start

    1. Winter
    2. Spring
    3. Summer
    4. Fall
13. Year

17. Event Holder Information (Required if purchasing insurance through Town)

19. Instructor Holder's Name*
21. Business DBA (if applicable)
23. Address*
25. City*
26. State*
27. Postal Code*
29. Phone Number*
30. Email Address*

34. Course Information

36. Course Title(s) / General Description*
38. Most Frequent Course Location*
40. Total Number of Classes Per Season*
42. Minimum Participant Age*
43. Maximum Participant Age*
45. Minimum Class Size (# of students)*
46. Maximum Class Size (# of students)*
48. Seasons Taught*

    1. Winter
    2. Spring
    3. Summer
    4. Fall
50. Sessions Per Day
52. Monday
    -- Select One --12345
53. Tuesday
    -- Select One --12345
54. Wednesday
    -- Select One --12345
55. Thursday
    -- Select One --12345
57. Friday
    -- Select One --12345
58. Saturday
    -- Select One --12345
59. Sunday
    -- Select One --12345

61. Course Enrollment Projection

    Please estimate your annual participant enrollment using the examples Provided on the last page of the Instructor Recreation Class Hazard Schedule.

    Enrollment Scenarios

    Using the example provided in the Instructor Recreation Class Hazard Schedule, please utilize your relevant course structure and provide the required quantities below. This information will be used to calculate your insurance rates, and you may need to repurchase insurance if you exceed your estimated threshold as specified by our Provider Alliant Special Events.

63. Your Estimated Annual Attendance*

67. Payment Information

69. • Processing Time: Please allow 24–48 hours. Incomplete or inaccurate submissions may result in delays.

    • Insurance Expiration: Coverage for instructors who purchased insurance through the Town expires December 31, of each year. Instructors must be reinsured before their first class in the New year to avoid cancellation.
    • Fee: Refer to the posted Instructor Recreation Class Hazard Schedule for current rates.

71. Payment Options

73. Credit Card (by phone)

74. Call 925-314-3405  • $2 fee for transactions ≤ $60  • 2.99% fee for transactions > $60

76. Check

77. Make payable to Town of Danville • Mail to: 233 Front Street, Danville, CA 94526, Attn: Facilities Management • Drop off: Danville Community Center (420 Front Street)   Mon–Thu: 8:30 AM–5 PM

79. Insurance Certificate

80. An email copy of your certificate should be sent address listed in the application upon processing. Insurance will not be processed until payment is received. Incomplete submissions may require resubmission.

Leave This Blank:


82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit

* indicates a required field