DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 49TH WING (ACC)

HOLLOMAN AIR FORCE BASE NEW MEXICO

Combat Airpower Starts Here

*this is a sample request/it is NOT tongue/quill compliant.

Organization is

Responsible to follow tongue/quill guidance…..06June 2017

MEMORANDUM FOR49 MSG/CC

FROM: NAME, President, Name of organization

SUBJECT: Request for Insurance Waiver

1. Members of the Name of organizationhave been briefed and understand that AFI 34-223, Private Organization (PO) Program, requires PO’s to buy and maintain adequate insurance protection against public liability and property loss or damage claims which may arise from activities of the organization and its members.

2. The activities of our organization include meetings, functions, and occasional fundraisers (no more than two per calendar quarter), consisting mainly of fundraisers with off-base restaurants, donations (once approved prior through 49 WG/JA), base yard sales with cookout, (once approved by Soaring Heights), and car washes.

3. Officers and members of this private organization have been briefed and understand that this waiver does not make the government responsible for any claim that arises from the activities of the organization or its members. The approving commander may still require liability insurance for specific events that involve a greater risk of injury or damage. Regardless of whether the waiver is approved, the officers and the member of this organization understand that we may be held jointly and severally liable for any claim that may arise out of the activities of this organization.

4. The organization’s activities involve only minimal risk of loss and damage. Therefore, on behalf of the membership, we request the 49 MSG/CC waive the insurance requirement.

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Name, Rank,

President, NAME OF ORGANIZATION

1st Ind to 49th WG/JA, 06 Jun 17

Review for Insurance Waiver

MEMORANDUM FOR Name, President, booster club name

Approved/Disapproved

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STAFF JUDGE ADVOCATE

2nd Ind to 49th Mission Support Group/CC, 06Jun 17

Request for Insurance Waiver

MEMORANDUM FOR Name, President, booster club name

Approved/Disapproved

Future events and activities, including fundraisers by the booster club name, that involves a greater risk of injury or damage may require the purchase of liability insurance. Each fundraiser will be evaluated on its own merits. The approval authority for any fundraiser request involving greater risk of injury or damage shall make a recommendation to the undersigned, who will make the final determination as to whether such activities and events require the purchase of liability insurance.Per IAW AFI 34-233, the waiver will be reevaluated annually.

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ANTHONY J. AJELLO, JR., Colonel, USAF

Commander. 49th Mission Support Group