Team Insurance List and Faxes Received		  
As of 7/21/2011
Faxes Received have been updated.  You can view your faxes to ensure we have the right information Three forms are required and must be sent in one fax transmission:
  1) Individual Entry Certification
  2) Certification, Eligibility and Release Declaration
  3) Sanction Meet 

If you are going to update your faxes, please re-fax all forms even if only one form is changing

Insurances should be faxed to the YMCA Of USA - 312-977-1069

Sample Certificate

Each team that participates in the meet must have a current and correct Certificate of Liability Insurance on file with the YMCA of the USA. Once this form has been submitted to the YMCA of the USA, it should serve to cover all YMCA of the USA sponsored events through the expiration date indicated on the certificate. In other words, a valid certificate that was filed prior to the Short Course Championship that has a long enough expiration date may cover the Masters Championship and the Long Course Championship as well. Exceptions are generally noted in the comments column.

Emails of certificates will be accepted FROM THE INSURANCE BROKER ONLY. Emails may be sent to Robin Lee .
Certificates of Insurance may be faxed to 312-977-1069, HOWEVER, THE ORIGINAL MUST STILL BE SENT to YMCA of the USA, Attn: Insurance Manager, 101 North Wacker Dr., Chicago IL 60606.

Please note: The insurance column may indicate one of four statuses:
No Date: YMCA of the USA has not yet received a valid insurance certificate. A valid insurance certificate must be received by the YMCA of the USA before the team may compete in a YMCA National meet.
Date only: The certificate has been received and is valid for all events until the date shown
Date with a code of SC, LC or M: The certificate has been received but is only valid for the meet(s) shown by the code letter (SC - Short Course Championship, LC - Long Course Championship, M - Masters)
Assoc Metro State Assoc_Name Certificate_Expiration Comments Fax_Received Date_Fax_Received
0012    AL  Birmingham Metropolitan YMCA  11/1/2011    Check Your faxes  Monday, July 18, 2011 
0124    AL  Prattville YMCA  3/31/2012    Check Your faxes  Thursday, July 14, 2011 
0951    CT  YMCA of Greenwich Inc.  1/1/2012    Check Your faxes  Monday, July 11, 2011 
0976    CT  Cheshire Branch YMCA  1/1/2012    Check Your faxes  Thursday, July 14, 2011 
0983    CT  East Hartford Branch YMCA  12/31/2011    Check Your faxes  Thursday, July 14, 2011 
0989    CT  New Canaan Community YMCA  3/31/2012    Check Your faxes  Saturday, July 16, 2011 
1025    CT  Wilton Family YMCA Inc.  12/29/2012    Check Your faxes  Monday, July 18, 2011 
1033    CT  Regional YMCA of Western Connecticut Inc  12/31/2011    Check Your faxes  Monday, July 18, 2011 
1041    CT  Southington-Cheshire Community YMCAs Inc.  1/1/2012    Check Your faxes  Saturday, July 09, 2011 
1055    CT  Northwestern Connecticut YMCA  12/31/2011    Check Your faxes  Friday, July 15, 2011 
1065    CT  Greater Waterbury YMCA  10/1/2011    Check Your faxes  Thursday, July 14, 2011 
1086    DE  YMCA of Delaware  8/1/2011    Check Your faxes  Friday, July 15, 2011 
1087    DE  Central Delaware Branch YMCA  8/1/2011    Check Your faxes  Sunday, July 17, 2011 
1089    DE  Brandywine Branch YMCA  8/1/2011    Check Your faxes  Friday, July 15, 2011 
1105    DE  Western Branch YMCA  8/1/2011    Check Your faxes  Friday, July 15, 2011 
1193    FL  YMCA of the Suncoast  5/1/2012    Check Your faxes  Saturday, July 16, 2011 
1285    FL  Central Florida Metro YMCA  6/1/2012    Check Your faxes  Monday, July 18, 2011 
1336    FL  Evalyn Sadlier Jones Branch YMCA  7/1/2012    Check Your faxes  Friday, July 15, 2011 
1341    FL  Tampa Metropolitan Area YMCA  6/1/2012    Check Your faxes  Monday, July 18, 2011 
1556    IL  The West Cook YMCAs  6/1/2012    Check Your faxes  Thursday, July 14, 2011 
1623    IL  Lattof International YMCA  10/1/2011    Check Your faxes  Friday, July 15, 2011 
1627    IL  Leaning Tower YMCA  10/1/2011    Check Your faxes  Thursday, July 14, 2011 
1635    IL  Buehler YMCA  10/1/2011    Check Your faxes  Monday, July 18, 2011 
1743    IL  Kishwaukee Family YMCA Inc.  9/5/2011    Check Your faxes  Friday, July 15, 2011 
1767    IL  Fayette County Family YMCA  3/19/2012    Check Your faxes  Friday, July 15, 2011 
1785    IL  Joliet Area YMCA  1/1/2012       
1843    IL  YMCA of Northwestern Dupage County  1/20/2012    Check Your faxes  Tuesday, July 19, 2011 
1855    IL  Greater Peoria Family YMCA  3/31/2012    Check Your faxes  Thursday, July 14, 2011 
2517    ME  Down East Family YMCA  1/1/2012    Check Your faxes  Friday, July 15, 2011 
2537    ME  Bath Area Family YMCA  10/1/2011    Check Your faxes  Monday, July 18, 2011 
2549    ME  Sanford-Springvale YMCA  7/1/2012    Check Your faxes  Monday, July 18, 2011 
2583    MD  Anne Arundel County YMCA  11/1/2011    Check Your faxes  Tuesday, July 19, 2011 
2601    MD  Catonsville Family Center Y  11/1/2011    Check Your faxes  Saturday, July 16, 2011 
2627    MD  Mid-Delmarva Family YMCA  4/12/2012    Check Your faxes  Thursday, July 14, 2011 
2637    MA  Andover/North Andover Branch YMCA  4/1/2012    Check Your faxes  Thursday, July 21, 2011 
2721    MA  Cape Cod Young Men's Christian Association  7/1/2012    Check Your faxes  Friday, July 15, 2011 
2769    MA  Greater Holyoke YMCA  10/15/2011    Check Your faxes  Thursday, July 14, 2011 
2837    MA  Hockomock Area YMCA  7/1/2011  Ins must be updated  Check Your faxes  Thursday, July 14, 2011 
2853    MA  Burbank Branch YMCA  9/30/2011    Check Your faxes  Thursday, July 14, 2011 
2854    MA  South Shore Mill Pond Branch YMCA  9/1/2011    Check Your faxes  Thursday, July 14, 2011 
2861    MA  YMCA of the North Shore  12/29/2011    Check Your faxes  Saturday, July 16, 2011 
2901    MA  YMCA of Greater Westfield Inc.  9/16/2011    Check Your faxes  Monday, July 18, 2011 
2973    MI  Farmington Family YMCA  6/3/2012    Check Your faxes  Friday, July 15, 2011 
3017    MI  YMCA of Greater Flint  5/10/2012    Check Your faxes  Sunday, July 17, 2011 
3031    MI  Southeast Branch YMCA  5/31/2012    Check Your faxes  Sunday, July 17, 2011 
3117    MI  YMCA of Saginaw  5/1/2012    Check Your faxes  Friday, July 15, 2011 
3586    NH  YMCA Allard Center  6/1/2012    Check Your faxes  Friday, July 15, 2011 
3685    NJ  YMCA of Fanwood - Scotch Plains  4/15/2012    Check Your faxes  Saturday, July 16, 2011 
3689    NJ  YMCA of Western Monmouth County  3/31/2012    Check Your faxes  Thursday, July 14, 2011 
3729    NJ  Wyckoff Family YMCA Inc  4/1/2012    Check Your faxes  Monday, July 18, 2011 
3741    NJ  Hunterdon County YMCA  10/1/2011    Check Your faxes  Thursday, July 14, 2011 
3765    NJ  Hamilton Area YMCA  5/15/2012    Check Your faxes  Saturday, July 16, 2011 
3786    NJ  Metuchen Branch YMCA  3/31/2012    Check Your faxes  Friday, July 15, 2011 
3791    NJ  YMCA of Montclair  3/31/2012    Check Your faxes  Tuesday, July 19, 2011 
3795    NJ  West Morris Area YMCA  1/1/2012    Check Your faxes  Friday, July 15, 2011 
3863    NJ  Ocean County YMCA  10/1/2011    Check Your faxes  Thursday, July 14, 2011 
3883    NJ  Family Health and Fitness Branch  5/1/2012    Check Your faxes  Monday, July 18, 2011 
3885    NJ  YMCA of Ridgewood  7/1/2012    Check Your faxes  Monday, July 18, 2011 
3915    NJ  Somerset Hills YMCA  4/1/2012    Check Your faxes  Friday, July 15, 2011 
3919    NJ  Somerset Valley YMCA  8/31/2011    Check Your faxes  Thursday, July 21, 2011 
4003    NY  GLOW YMCA, Inc.  8/25/2011    Check Your faxes  Friday, July 15, 2011 
4063    NY  Greater Canandaigua Family YMCA  4/1/2012    Check Your faxes  Thursday, July 14, 2011 
4077    NY  Cortland County Family YMCA  8/1/2011    Check Your faxes  Tuesday, July 19, 2011 
4115    NY  Family YMCA of Glens Falls Area  12/31/2011    Check Your faxes  Monday, July 18, 2011 
4181    NY  The YMCA East Hampton RECenter  7/15/2012    Check Your faxes  Tuesday, July 12, 2011 
4256    NY  Flushing Branch YMCA  4/1/2012    Check Your faxes  Thursday, July 14, 2011 
4480    NC  YMCA of Western North Carolina Inc.  10/1/2011    Check Your faxes  Monday, July 18, 2011 
4510    NC  Chapel Hill-Carrboro YMCA  1/1/2012    Check Your faxes  Thursday, July 14, 2011 
4540    NC  YMCA of the Sandhills  10/11/2011    Check Your faxes  Thursday, July 14, 2011 
4549    NC  Kathleen Price Bryan Family YMCA  8/1/2011    Check Your faxes  Monday, July 18, 2011 
4579    NC  Hickory Foundation YMCA  1/1/2012    Check Your faxes  Monday, July 18, 2011 
4598    NC  YMCA of the Triangle Area  4/1/2012    Check Your faxes  Thursday, July 14, 2011 
4600    NC  Twin Rivers YMCA  7/1/2011  Ins must be updated  Check Your faxes  Friday, July 15, 2011 
4622    NC  YMCA of Wilmington Inc.  8/1/2011    Check Your faxes  Thursday, July 14, 2011 
4625    NC  J.F. Hurley Family YMCA  8/31/2011    Check Your faxes  Tuesday, July 19, 2011 
4626    NC  YMCA of Northwest North Carolina  7/1/2012    Check Your faxes  Friday, July 15, 2011 
4800    OH  Don M and Margaret Hilliker YMCA  10/25/2011    Check Your faxes  Thursday, July 14, 2011 
4805    OH  Blue Ash Branch YMCA  1/1/2012    Check Your faxes  Saturday, July 16, 2011 
4817    OH  M.E. Lyons Family Branch YMCA  1/1/2012    Check Your faxes  Saturday, July 16, 2011 
4827    OH  Powel Crosley Jr. Branch YMCA  1/1/2012    Check Your faxes  Monday, July 18, 2011 
4915    OH  Ridgewood Branch YMCA  12/31/2011    Check Your faxes  Monday, July 18, 2011 
4971    OH  Hilltop YMCA  6/30/2012    Check Your faxes  Monday, July 18, 2011 
5018    OH  Coffman Family YMCA  8/1/2011    Check Your faxes  Saturday, July 16, 2011 
5023    OH  South YMCA  8/1/2011    Check Your faxes  Monday, July 18, 2011 
5025    OH  Ralph J. Stolle Countryside YMCA of Warren Co.  10/11/2011    Check Your faxes  Saturday, July 16, 2011 
5065    OH  Fairfield Family Branch YMCA  1/1/2012    Check Your faxes  Saturday, July 16, 2011 
5083    OH  Family YMCA of Lancaster & Fairfield County OH  9/1/2011    Check Your faxes  Thursday, July 14, 2011 
5119    OH  Middletown Area YMCA  1/1/2012    Check Your faxes  Thursday, July 14, 2011 
5127    OH  The Licking County Family YMCA  1/1/2012    Check Your faxes  Tuesday, July 12, 2011 
5219    OH  Eastern Community Branch YMCA  9/15/2011    Check Your faxes  Friday, July 15, 2011 
5265    OH  Beavercreek Branch YMCA  8/1/2011    Check Your faxes  Monday, July 18, 2011 
5549    PA  Chambersburg Memorial YMCA  10/20/2011    Check Your faxes  Friday, July 15, 2011 
5566    PA  Jennersville YMCA  7/1/2012    Check Your faxes  Friday, July 15, 2011 
5637    PA  West Shore Branch YMCA  7/1/2012    Check Your faxes  Tuesday, July 19, 2011 
5647    PA  Indiana County YMCA  2/4/2012       
5657    PA  Greater Johnstown Community YMCA  5/4/2012    Check Your faxes  Thursday, July 14, 2011 
5695    PA  Tri-Hampton Family Branch YMCA  7/1/2012    Check Your faxes  Monday, July 18, 2011 
5711    PA  Mon Valley YMCA  1/8/2012    Check Your faxes  Thursday, July 14, 2011 
5781    PA  Ridley Area Branch YMCA  1/1/2012    Check Your faxes  Friday, July 15, 2011 
5839    PA  East Suburban Family Branch YMCA  1/1/2012    Check Your faxes  Friday, July 15, 2011 
5895    PA  Pottstown YMCA  3/31/2012    Check Your faxes  Thursday, July 14, 2011 
5908    PA  Boyertown Area YMCA  7/1/2012    Check Your faxes  Thursday, July 21, 2011 
5923    PA  Regional Family YMCA of Laurel Highlands  10/29/2011    Check Your faxes  Saturday, July 16, 2011 
5938    PA  State College Family YMCA  1/2/2012    Check Your faxes  Friday, July 15, 2011 
5966    PA  Lionville Community YMCA  9/1/2011    Check Your faxes  Thursday, July 14, 2011 
5967    PA  Upper Main Line Branch YMCA  9/1/2011    Check Your faxes  Tuesday, July 19, 2011 
5985    PA  Kennett Area YMCA  7/1/2012    Check Your faxes  Monday, July 18, 2011 
6088    SC  Newberry County Family YMCA  12/31/2011    Check Your faxes  Thursday, July 14, 2011 
6109    SC  Columbia Northwest Family YMCA  10/1/2011    Check Your faxes  Thursday, July 21, 2011 
6135    SC  Middle Tyger YMCA Family Center  7/24/2012    Check Your faxes  Friday, July 15, 2011 
6152    SC  Rock Hill Aquatics Center  7/15/2012    Check Your faxes  Friday, July 15, 2011 
6682    VA  Piedmont Family YMCA Inc.  6/20/2012    Check Your faxes  Friday, July 15, 2011 
6712    VA  Rappahannock Area YMCA  1/1/2012    Check Your faxes  Thursday, July 14, 2011 
6740    VA  Greenbrier Family YMCA  1/1/2012    Check Your faxes  Saturday, July 16, 2011 
6753    VA  Portsmouth YMCA  1/1/2012    Check Your faxes  Saturday, July 02, 2011 
6989    WV  Tri-County YMCA Inc.  7/1/2012    Check Your faxes  Thursday, July 14, 2011 
6999    WV  YMCA of Elkins West Virginia  1/1/2012    Check Your faxes  Sunday, July 17, 2011 
7015    WV  YMCA of Huntington West Virginia  10/1/2011    Check Your faxes  Thursday, July 14, 2011 
7031    WV  J.B. Chambers Branch YMCA  11/1/2011    Check Your faxes  Monday, July 11, 2011 
7033    WI  YMCA of the Fox Cities Inc  9/1/2011    Check Your faxes  Thursday, July 14, 2011 
7061    WI  Greater Green Bay YMCA Inc.  1/1/2012    Check Your faxes  Thursday, July 14, 2011 
7066    WI  Door County YMCA  1/1/2012    Check Your faxes  Friday, July 15, 2011 
7155    WI  Oshkosh Community YMCA  1/1/2012    Check Your faxes  Friday, July 15, 2011