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o <br /> $'c sze tc 3 ., _1 <br /> s MrtiO s .4 .✓ IH...cID�.P l PT FOI <br /> 'x as--&L � yn• °� z , S- ty .7-',1,414:1142.4:4,`,..2;,,, = -" 5•1 "r <br /> : , ...,o-•.,.>.. <br /> A participant includes a driver,throttleman, It is the responsibility of the chief referee and the <br /> navigator,mechanic,official,or anyone else race promoter to see that any incident that takes <br /> who has a duty necessary to the conduct of a I place during a sanctioned APBA event is recorded <br /> sanctioned APBA event for which the fee has on the incident report form and submitted by mail ! <br /> / been paid in full and who has signed an APBA- i no later than one day following the event. <br /> t approved waiver and release t <br /> CLAIMS PROCEDURE <br /> .r .,AB;A1 -Aivull AND C w Asf - w. �._ . F: .,_ � _ L <br /> -L,-.;;----,--_,-___: -..;.. . '" In the event of a fatality,spectator injury,or trans- <br /> The APBA Waiver and Release ofLiability,As- port to the hospital, promptly call American <br /> sumption ofRisk,and IndemnityAgreement is Specialty's emergency claims service at 800-566- <br /> a mandatory legal document that acknowl- 7941.This number is accessible 24-hours a day. <br /> edges that each participant accepts full respon- <br /> sibility for participating in the APBA-sanctioned If a demand is made for damages(for either bodily <br /> event. It is an important element of the incur- injury or property damage liability),a complete, <br /> ance protection that an approved waiver and I detailed incident report must be provided to <br /> release be signed by each participant and each i American Specialty Insurance Services,Inc. <br /> person granted access to any restricted area. i Copies of any demands,summons,and legal pa- <br /> All member participants who have signed the I 1 pers are to be provided to American Specialty <br /> approved waiver and release form and who 1 Insurance Services,Inc. <br /> possess a valid APBA pit identification are eli- <br /> gible for accident medical coverage. No cov- I i M kit,COMPLETED INCIDENT REPORT.S"T 0: <br /> erage is provided for any person who is not I `, <br /> defined as a participant. f <br /> �� .. g <br /> ➢I' � AMERICAN SPECIALTY' <br /> A" tg• ` '- I P.O. Box 459 <br /> 4 � ig =Adult 'lta ¢ 1 ROANOKE, IN 46783-0459 <br /> an e 7 -.._49 -` mustsignther--# rf1. a > • ifS ,r-i,-rz <br /> - .- .:- �-`rty,,, l: The information contained in this brochure. is <br /> £e -, a °$E r tr a a i 8 r re 4-e./41,;-.77 k <br /> s itt- 1ikt. % �a suminarr.of•the benefits pros aced. It is NOT <br /> r . t a complete i planation o1' •all the pros isions of <br /> �• ". i t the olid' or specifics of the'iolic� benefits: <br /> � s=� . k. ---� i No uIserage is extended and no rept'esenti- <br /> '� : . cil�erelal�trec=tu� atnlg� � <br /> E � r tions are made other than ss liit is stated in <br /> .. 1� .idult \\air ei ait�; eleW <br /> r ,e I the polic\ hor .t complete description of <br /> c rine \cais ' . <br /> y ilkut tepolp1 o rant co\crages exclusions. and benefits. <br /> t _ a ` i iSsubmrtted Rt , please rete to the polus <br /> .;_:,. ...41. 4 <br /> h �• <br />