Central Districts Field Days
Public Liability Insurance Acknowledgement

Company Name: / Site number:
(“Exhibitor”)

It is a requirement of the Central Districts Field days (“Organiser”) terms and conditions that all exhibitorswho answer “yes” to any of the questions listed in the table below must have public liability insurance cover for an amount not less than $2,000,000.00 (“Cover”).

All of those who require Cover must provide proof of Cover or a sworn affidavit to the same effect to the Organiser prior to 20 January 2016. If an exhibitor is required to have Cover and does not have their own the Organiser will extend Cover to the exhibitor under the Organiser’s insurance for a fee of $50.00 including GST which will be invoiced to the exhibitor.

A summary of the Cover available under Fairfax New Zealand’s Exhibitors Public Liability policy is as follows:

Insurer:Vero Liability Insurance Limited

The Insured:Exhibitors and site holders as declared to the insurer

The Business Description:Exhibitor and site holder at Fairfax New Zealand Limited Central DistrictFieldDaysevent

Period of Insurance: Actual number ofdaysof the event, including set up and set downdays

Limit: $2,000,000 any one occurrence

Excess:$1,000

Important Exclusion – Products Liability:The policy does not apply to third party property damage or personal injury caused by, arising out of or in any way connected with your products.

If evidence of Cover is not received by 20 January 2016 it will be assumed that the exhibitor requires Cover under the Organiser’s insurance and the exhibitor will be invoiced accordingly. Where the exhibitor has their own Cover the Organiser will not be responsible for any claim against the exhibitor.

Please answer the questions below and indicate whether the Exhibitor has its own Cover or will be requiring Cover under the Organiser’s insurance.

If the Exhibitor answers“Yes” to any of the below questions Cover will be required:

The Exhibitor will have a marquee/tent/gazebo at the event: / Yes / No
Will there be any sharp objects within the Exhibitor’s site: / Yes / No
Will there be any heavy equipment within the Exhibitor’s site: / Yes / No
Will there be any water features deeper that 30mm within the Exhibitor’s site: / Yes / No
Will there be any mechanical devices within the Exhibitor’s site: / Yes / No

Please tick the option which applies:

  1. The Exhibitor did not answer Yes to any questions above and does not require cover; or

  1. The Exhibitor has the required Cover and will provide evidence of this to the Organiser; or

  1. The Exhibitor requiresCover under the Organisers public liability insurance and agrees to pay the $50.00 fee for this service.

Please indicate whether the following applies:

The Exhibitor has previously supplied proof of Cover to the Organiser, the Cover has been renewed and no changes have been made. / Yes / No

By signing below the Exhibitor acknowledges its public liability insurance requirements as an exhibitor at the Field days and warrants that the answers to the above questions are true and correct. Please send any cheques to Fairfax NZ Ltd, Private Bag 4906, Christchurch 8140. Once complete please sign and return the form Christine O’Connor at the address below.

Signed on behalf of,
Company Name:
By its authorised signatory:
Name of Authorised Signatory:

Central Districts Field Days Ltd |

Palmerston North (Sales Office)PO Box 3, Palmerston North 4410| P: 64 6 354-0000 | F: 64 6 354 2412 |

Auckland (Admin) PO Box 90741, Victoria St West, Auckland 1142 | P: 64 9 374 4762 | F:64 9 970 4045 |