Vendor & Exhibitor Liability Application

Vendor/Exhibitor Insurance Application
Company Name*
Full Name

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Years Experience
Your website address

General Information
Do you operate a food truck?
Products sold/exhibited*
Include Products Liability
Size of selling area*
Estimated attendance at your booth*
Desired effective date*

MonthDayYear
Desired expiration date

MonthDayYear
Who was your previous insurance company?*
Any previous claims (last 5 years)?*
Explain any previous claims

Event Information (1st Upcoming Event)
Name of the event or description
Event dates
Name of Venue/Location
Venue Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What limits of liability does the venue require? (Found on your rental agreement)

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.

Desired Policy Term
Premium Includes:

Policy Limits: $1,000,000 per Occurrence / $2,000,000 Aggregate

Personal and Advertising Injury

All additional insureds (where required)

Contractual Liability

No Deductible

Products Liability (subject to company approval)*

No limits on number of events

*Higher rates will apply for Food Trucks

*We are unable to provide Products Liability if you are involved in the sale/demostration of auto parts, weapons, exercise equipment, motorized equipment/vehicles, chemical based cleaning products, fire safety equipment, protective equipment/apparel, toys, notritional/health supplements, beauty care products or electrical appliances. In these cases your policy will be issued excluding Products Liability.

Risks NOT elegible: Animal acts or rides, Petting zoos, Medical Tests, Body piercing, Tattoos (permanent), Activities involving bodily contact, Hazardous products, Mechanical devices

Notable Exclusions: Injury to employees; Atletic participants; Medical payments; Damage to property you own, rent or occupy; Collapse of temporary structures; Automobile, aircraft and watercraft liability; Fireworks; Liquor liability.

Optional / Additional Coverage

Volunteers and Spectator Accident Medical
Number of volunteers daily
Total No. of volunteers all days
Do you want spectators to be included on coverage?

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*

MonthDayYear
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