Exhibitors Insurance Application

Conference:

Thurs., May 12, 2016, Fri., May 13, 2016,

Trade Show:

Sat., May 14, 2016, Sun., May 15, 2016

EXHIBITORS INSURANCE APPLICATION

I – EXHIBITOR DETAILS

Name of Exhibitor (full legal name that should appear on the Certificate):

Booth #:

Type of Business:

Mailing Address:

Unit / Suite:

City:

Province:

Postal Code:

Phone:

Fax:

*Email Address:

Exhibitor Contact Name:

Signature:

Date:

II – EVENT DETAILS

Show Organizer: Canadian Health Food Association

Address: 235 Yorkland Blvd., Suite 302, Toronto, Ontario M2J 4Y8

Event Name: CHFA West 2016

Location of Event: Vancouver Convention and Exhibition Center, 1055 Canada Place, Vancouver, BC V6C 0C3

Event Date: From 12 May 2016 to 15 May 2016

III – PAYMENT TERMS AND CONDITIONS

Preferred Rate (for payment postmarked on or before 19 April 2016) – Premium $195.00 plus $15.60 P.S.T. = $210.60 TOTAL

Regular Rate (for payment postmarked on or after 20 April 2016) – Premium $210.00 plus $16.80 P.S.T. = $226.80 TOTAL

Credit Card * VISA/MasterCard No._______________________________________________

Expiry Date: (MM/YY) __________________

A certificate will be sent directly to the CHFA on your behalf, and a copy will also be sent to the email address* above, if provided.

Please make your cheque or money order payable to BFL CANADA and remit with application to:

BFL CANADA RISK & INSURANCE SERVICES INC., 181 University Avenue, Suite 1700, Toronto, ON M5H 3M7

Phone: 416-849-3098

Toll Free: 1-800-668-5901 ext 3098

Fax: 416-599-5458

Email: asingh@bflcanada.ca

Note: The above insurance program will be offered only if the application form is signed and completed in full, and the payment and the application form are received in our offices prior

to 12 May 2016, the opening show date. Completion of this application does not automatically bind coverage. This application is subject to being approved prior to binding. Premium is

minimum and retained. Coverage is void if payment is returned N.S.F. A full copy of this policy is available upon request.

IV – SCHEDULE OF COVERAGES

$25,000 Property of Every Description (at the designated booth space) – Broad Form, subject to $1,000 deductible per occurrence

Note: Property excluded from coverage – Electronic Data Processing, audio and video equipment, watches, jewellery made of precious stones and / or precious metals, money, bullion,

securities, stamps, antiques, furs, fine arts valued at $5,000 per item or greater.

$3,000,000 Comprehensive General Liability – Bodily Injury and Property Damage Liability, subject to $1,000 deductible inclusive each occurrence. Includes Employees as Additional

Insureds, Contingent Employers Liability, Broad Form Property Damage, Cross Liability Clause, Severability of Interest Clause.

$100,000 Tenants Legal Liability, Broad Form

Coverage is subject to: Asbestos Exclusion, Fungi & Fungal Derivatives Exclusion, Data, War, Nuclear, Property Flood and Earthquake exclusions. Territory Restriction: Location of

event as described above. This schedule of coverage provides all coverages for the exhibitors’ own property up to $25,000 while at the event as well as 3 days transit to and from the

event.

Ineligible risks: Chemicals, Fertilizers, Firearms, Pesticides, Fireworks, Computers, Alcoholic Beverages, Games, Licensed or Unlicensed Motorized Vehicles, including but not limited

to Motorcycles, Watercrafts, All Terrain Vehicles, and Tractors. Note: There is no liability coverage for vehicles in motion.

Insurer: Sovereign General Insurance Company

By completing this application and returning it to BFL Canada Risk & Insurance Services Inc. you agree and consent to the collection, use and disclosure of such information, including

any personal information, by BFL CANADA Risk & Insurance Services Inc. for the following purposes:

 Communicating with you

 Negotiating, maintaining or renewing insurance on

 Advising you of other products or services

 Accessing your application for insurance

your behalf

 Complying with regulators and legal authorities

 Providing claims assistance and service

 Disclosing information to insurance companies

. For more information about our privacy policies and practices or for a copy of our Privacy Policy please contact:

Doug Sills, BFL CANADA Risk & Insurance Services Inc. – Email

dsills@bflcanada.ca