Group Meetings Insurance

Do you need written documentation of insurance coverage by Indivisible Project (Certificate of Insurance)?*

Yes No

Great news! If you don't need documentation of insurance, you don't need to fill out this form. Indivisible Project's insurance may cover informational meetings of local groups organizing in accordance with our principles. It unfortunately will not cover demonstrations, rallies, protests, or strikes. The informational meeting of your local group may be covered by Indivisible Project's insurance if: a) neither you nor any group leaders or members will encourage or condone any unlawful activities or activities that may cause physical harm to the space or any individual using the space; and b) you have not promoted the meeting as being related to a demonstration, rally, protest, or strike, and will not use the meeting for such purposes.

Group Information

Indivisible Group Name*

Indivisible Group State*

Point of Contact Name*

First Name

Last Name

Point of Contact Email*

Confirm Point of Contact Email *

This point of contact email is where the documentation of insurance coverage will be sent.

Point of Contact Cell Phone Number (Optional)

By providing your cell phone number you agree to receive calls and texts about important updates, ways to take action, and information about events in your area from Indivisible, approximately three times a month. Message and data rates may apply. Reply with STOP to quit receiving texts.

Meeting Information

Meeting Name*

Meeting Venue Name*

The name of the meeting venue will appear as "Certificate Holder" on the Certificate of Insurance.

Meeting Venue Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Meeting Date*

Purpose for which you are seeking meeting space*

Meeting Venue Phone Number*

Meeting Venue Email*

Confirm Meeting Venue Email *

Meeting Space Cost* $

What Lines of Coverage would you like on the Certificate of Insurance?

Commercial General Liability

By submitting this form, I agree that all of the above information is true and accurate. I agree and acknowledge that Indivisible Project will assist local Indivisible groups in accessing the space described solely through providing a Certificate of Insurance. I agree and acknowledge that Indivisible Project has not directed or controlled the activities occurring in the space. I agree that neither I nor any other group leader will encourage or condone any unlawful activities or activities that may cause physical harm to the space or any individual using the space. I understand and agree that insurance coverage arranged through the Indivisible Project will not extend to demonstrations, rallies, protests, or strikes, and I agree that I will not use the space I have procured in connection with this agreement for the purposes of such actions or promote informational meetings covered by Indivisible Project’s insurance as demonstrations, rallies, protests, or strikes. I agree that I will comply and I will instruct group members to comply with the terms of this agreement, any other agreement relating to the use of the community space outlined in this agreement, and any person with authority over the use of that space.

I agree