Your Name

Your Phone

Your Email

Event Organizer Company Name

Insurance Agency

Insurance Agent's Name

Insurance Agent's Referral ID

1) Does the event include any of the following?

2) The event will take place in the USA or Canada?

3) Confirm only one event can be covered per policy.

4) Any Bounce houses or inflatables?

5) Any private armed security?

Operation Type

Description of Business

1) Any insurance declined or cancelled in the past three years?

2) Any loss in the past three years?

3) Any prior insurance coverage?

Event Type

Event Name

Event Description

Cost/Budget

Artist/Band

Required, if live music or concert event

Indoor Outdoor

Attendees

Dates

Name

Address

City

Country

State or Province

Zip

Vendor's Liability

Your client is automaticaly covered for claims arising out of the vendors activities (unless the activities are excluded on the policy). By inputting the information below and providing a schedule subjest to underwriter’s review, for an additional premium the vendors coverage will be extended to allow for vendors to be covered should they be named in a suit.

# of Exhibitors

# of Food Concessionairs

# of Non Food Concessionairs

# of Attractions/Performers

Equipments, Props, Sets, Wardrobe (Rented)

Equipments, Props, Sets, Wardrobe (Owned)

Rented Furs, Jewelry, Art & Antiques Coverage

Extra Expense

Third Party Property Damage

Hired & Non-owned Auto Physical Damage (per vehicle/aggregate limit)

Rental Cost Reimbursement

Waiver of Subrogation

Coverage Extension Endorsement

Occurence/Aggregate Limit

Fire Legal

Medical Payments

Blanket Additional Insured/Certificates of Insurance

City/Other Special Certificates

Waiver of Subrogation

Liquor Liability

Abuse & Molestation (Each Claim/Aggregate)

Hired/Non-Owned Liability

Waiver of Subrogation

Occurrence/Aggregate Limit

Limits

Waiver of Subrogation

All States Endorsement (other than monopolistic states)

Accidental Medical Benefit (Death/Dismemberment/Medical)

Covered Individuals