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USA Pickleball Sanctioning

Certificate of Insurance Request

Certificates of Insurance are issued as proof of insurance coverage to a third party or certificate holder, such as the owner of a tournament venue. USA Pickleball’s insurance does not name the venue itself as an Additional Insured. Tournament Director: please complete all sections of this form to receive a Certificate of Insurance.

Name

This field is for validation purposes and should be left unchanged.

Tournament Information

Name of Pickleball Tournament(Required)

Start Date(Required)

End Date(Required)

Estimated Participants(Required)

Untitled

Venue Information

Venue Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Venue Contact Name(Required)

Venue Contact Email(Required)

Venue Contact Phone(Required)

Certificate Information

Does the Certificate Holder require Additional Insured status?(Required)

Yes

No

Please specify “additional insured” wording as it should appear(Required)

Other named USA Pickleball Additional Insureds*(Required)

Yes

No

Provide names as they should appear if different than above

Tournament Director Information

Director Name(Required)

Director Email(Required)

Director Phone(Required)

Director Address(Required)

Street Address Address Line 2 City State ZIP Code

Directors Signature(Required)