Annual Production Insurance
Short Term Production Insurance
Special Events Insurance
Named of Insured
Phone / Fax
Year Business Established
Description of Operations
Check YES if the event will take place in the United States.
Check YES if you understand only one event can be covered per policy.
Check YES if any bounce houses or inflatables will be used.
Check YES if any private armed security will be employed.
Check YES if the event includes any of the following: Stunts, Pyrotechnics, Aircrafts, Hazardous Activities, Car Races, Precision Driving, Mechanical Amusement Devices, Film Production, Live Rap or Hip-Hop Performances
Check YES if you have experienced any losses in the last 3 years.
If so, please describe here.
Average Daily Spectators
Tear Down Date
Name of Venue
Date of Coverage
Occurrence / Aggregate Limit
Do your vendors your locations require special insurance?
Rented Equipment (camera, lighting, sound)
Rented Props, Sets, Wardrobes
Owned Equipment Props, Sets, Wardrobes
Negative Film, Videotape, Images
Third Party Property Damage
Check YES if you require Hired and Non-Owned Liability coverage.
Check YES if you require Hired and Non-Owned Physical Damage Liability coverage.
Check YES if you require Workers Compensation coverage.
Check YES if you require Travel Accident coverage.