Express Short Term Production Application

Express Short Term Production Application

This express application is not for all available coverages. It is for rented equipment, general liability, location damage if selected. If you need a policy to include workers compensation or additional coverages please fill out the Full Production Application.
For Feature Films, Documentaries, Short Films, Music Videos, Commercials, Etc.

Click here for Insurance Terms & Definitions.
APPLICANT INFORMATION
How did you hear about us? *
Select how you found our website.
Insured Name *
The name of your production company or entity (or individual name if not incorporated) you would like to insure. Use the same name as on your rental quote.
Entity Type *
Full Name *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *

Confirmation Email
Website
Description of your operations: *

UNDERWRITING QUALIFICATION

Please answer the following questions to determine if the production qualifies for short term production insurance.
Will you need coverage for any shooting outside of the USA? *

Yes No
Does your production have any of the following? *

Yes No
Stunts, Falls, Fight Scenes, Pyrotechnics, Fireworks, Airplanes, Helicopters, Drones, Hangliders, Hot Air Balloons, Parachutes, Boats, Water Scenes, Animals, ATVs, Go Carts, Mopeds, Motorcycles, Scooters, Segways, Snowmobiles, Weapons, Firing & Non-Firing Prop Guns, Blanks, Squibs, UAV (Drones), Animals, Hard-core or Soft-core Porn, Precision Driving, or Chase Scenes?
If yes, please describe. *
Have you had any prior insurance coverage / losses? *

Yes No
If yes, please explain: *

PRODUCTION DETAILS
Project Title *
Project Synopsis *
2-3 sentences describing your film's story.
Type of Production *
Artist Name *
Genre of Music *
Brief description of the music video: *
Total Gross Production Budget *
Estimated costs, including overhead, chargeable directly to the production stated at the time of declaration of an insured production or series of productions. The following costs are not included: story, scenario, music rights, sound rights, royalties, residuals, continuity, premiums paid for the insurance, interest on loans and taxes.

Filming Locations: (One Per State) *

	Street Address	City	State	Zipcode	Name of Venue
Location 1
Location 2
Location 3
Location 4

Coverage Start Date *

Month Day Year
Date
Coverage End Date *

Month Day Year
Insurance exp. is 12:01am. If your last day or filming is April 25th use April 26th as the last day of coverage (as it will expire on 04.26 12:01am).
Are you renting equipment? *

Yes No
Equipment Pickup Date *

Month Day Year
Date
Equipment Drop Off Date *

Month Day Year
Date

INLAND MARINE

Property Coverage such as rented camera equipment etc.
Rented Equipment Limit
(total replacement cost value)
How will rented equipment be secured overnight?
Will the rented equipment stay with you at all times?

Yes No
Will the equipment be transported in protective cases?

Yes No
Third Party Property Damage
(Damage to rented premises such as a shooting location). Not the same as General Liability.
GENERAL LIABILITY

General Liability covers payments the insured will become legally obligated to pay as a result of Bodily Injury or Property Damage arising out of an occurrence during filming activities, live events or performances. Applies to third parties, excluding your own cast and crew, location. Injury to your own cast and crew can be covered under workers compensation, if selected. If you would like a quote with workers compensation a separate application is be required.
General Liability Limit *
Film permit offices, locations typically require the $1M liability limit.
Excess General Liability Limit
Select only if higher limits are required. Film permit offices, locations typically require the standard $1M liability limit.

Additional Information, Comments
Additional Information or Comments, if necessary, can be provided.
Would you like to receive a complimentary Errors and Omissions quote for your completed film?

Yes No
Terms and Conditions

Please carefully review the Terms and Conditions below:
- I represent that this application form has been completed after proper inquiry and, based on this inquiry, I represent the application contents are true, accurate, and not misleading.
- I represent that I understand and agree that if any of the contents of this application are intentionally untrue, inaccurate, or misleading, in any material respect, or if I fail to notify the insurance company of additional information that might render the contents of this application untrue, inaccurate, or misleading, in any material respect, then the insurance company is entitled to rescind any policy issued pursuant to this application.
- Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties. Please click the link below for individual state notices.
- I represent that I understand and agree that this application and all materials submitted in connection with this application are incorporated into and form the basis of any policy issued by the insurance companypursuant to this application.
- I represent that by signing this application I am representing that I am duly authorized to execute insurance contracts on behalf of the entity applying for this coverage and that all representations (whether verbal or written) made in connection with this application are made on behalf of and shall be fully binding upon such entity.
- A quotation received is not binding on the Insurer in any way.
- By clicking 'Submit Application' you are not agreeing to purchase coverage. If terms can be offered you will receive a free, no-obligation insurance quotation via email. All quotes require underwriter’s approval and payment prior to binding. Please read all exclusions indicated on the quotation.
- Please note that once coverage is bound, the policy cannot be cancelled.
- The insurance quotation will be based solely on the coverages and limits selected on this application.
- Please ask your Film Emporium, Inc. representative to further explain coverage details, exclusions (including stunts and/or other hazardous activities), limits or other provisions of any insurance policy, or to request a sample policy form.
By submitting this application you indicate that you have read and accepted the Terms and Conditions above.
Do you accept these terms and conditions? *

I Agree
Would you like to recive our quarterly newsletter? *

Yes No
Should be Empty:

Express Short Term Production Application

UNDERWRITING QUALIFICATION

PRODUCTION DETAILS

INLAND MARINE

GENERAL LIABILITY

Additional Information, Comments