Special Event Insurance Quote Request

General Information
Is Event Indors or Ourdoors? *
Name of the Event *
Type of Policy *
Describe "Other"
Event dates *
Total No. of Shows/Performances *
Time Event *

: Hour Minutes AM/PM Option
until
until : Hour Minutes AM/PM Option
Would all attendees have left the venue by midnightof your last event date?
Desired Effective Date (Load-in-Date) *

Month Day Year
Load-out Date

Month Day Year
Desired Expiration Date (Usually 1 day after load-out date) *

Month Day Year
Detailed Description of the Event (If there any live performances, list all artists along with type of music) *
Upload any flyers or promotional material (if available)
Location Capacity *
Estimated Daily Attendance (spectators) *
Estimated Total Attendance (All days) *
If There are Any Performances, or Athletes, Do you Want Participants Covered?
Estimated Number of UNPAID Performers or Participants
Decribe Participants (Example: Band Members, Theater Cast, Soccer Payers, etc,)
List Names of All Performing Bands, Groups, Artists, Celebrities, Etc.
Admission Charge for the Event
Number of Non-Food Vendors *
Number of Food Vendors *
Will Food Vendors (If Any) Have Their Own Insurance?
Number of Attractions, Games, Etc. *
Budget Cost for this Event
Estimated Gross Receipts

Venue Information
Name of Venue/Location *
Venue Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Will the event take place at more than one location?
If more than one location please include schedule
What limits of liability does the venue require? (Found on your rental agreement) *
Who is supplying the security? *
Is security armed? *
Type of Security (Uniform, Peer Group, Ushers, Etc.)
How many of each?
Type of Seating (folding, bleanchers. etc.) *
Seating is

Underwriting Information
List anyone else (other than venue) that need to be listed as additional insured on your policy, include name and complete mailing address.
Are you responsible for parking? *
Is parking lot attended?
Will event include any Stunts, Pyrotechnics, Aircraft, Pools, Lakes or other bodies of water, Car Races, Rides, Moon Bouncers, Inflatable Activities or other Hazardous Activities? *
If Yes Explain:
Who is responsible for setting up the stage and temporary seating? *
Who was your previous insurance company?
Any previous claims (last 5 years)? *
Explain any previous claims
Would you like an annual quote insuring all of the events you have planned for the next 12 months?

Liquor Liability
Are you directly selling, or sharing income from the sale of alcohol?
What name is the liquor license filed under?
Who is serving (location, caterer, you, etc.)
Estimated total liquor sales?
Describe procedures & safeguards for preventing the serving of alcohol to minor or intoxicated persons

Hired and Non-Owned Automobile
No. of vehicles rented or borrowed?
No. of vehicles used by employees?
Total cost to rent vehicles?
Any vehicle seat more than 10 passengers?
If physical damage to rented vehicles is desired, what is the maximum value of any one vehicle?
What is the total value of all vehicles?

Workers Compensation
Name of payroll company (is any)
Employers' Federal ID Number
List No. of Full Time / Part Time employees and Payroll per duties/class code
List full names and titles of all owners and officers. Coverage will be excluded for these persons

Weather Insurance
Coverage date

Month Day Year
Coverage time

: Hour Minutes AM/PM Option
until
until : Hour Minutes AM/PM Option
Policy limit
Include the following perils (check all that apply)

Rain Lighting Snow Wind
List any additional dates and times for coverage

Prize Insurance
Describe to us the type of prize promotion you want including the value of the prize

Application Warranty and Signature
I HEREBY WARRANT AND CONFIRM THAT THE ABOVE INFORMATION, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT, AND FURTHER CERTIFY THAT I HAVE READ ALL OF THE QUESTIONS AND ANSWERS OF THIS APPLICATION. I UNDERSTAND THIS APPLICATION IS A REQUIREMENT FOR COVERAGE, A PART OF THE CONTRACT AND EVIDENCE OF MY ACCEPTANCE OF THIS INSURANCE, AND ANY FALSIFICATION OR MISREPRESENTATION WILL BE DEEMED A BREACH OF CONTRACT, VOIDING ALL INSURANCE COVERAGE. IT IS UNDERSTOOD AND AGREED THAT THE COMPLETION OF THIS APPLICATION SHALL NOT BE BINDING EITHER TO THE PROPOSED INSURED OR THE COMPANY UNTIL ACCEPTED BY THE COMPANY OR COMPANIES IN WRITING. *

I Accept
Name of person acknowledging Warranty *
Title *
Date of acknowledgment *

Month Day Year
Should be Empty: