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Forms
Entertainment – Special Event (Annual)
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Entertainment - Special Event (Annual)
CLIENT INFORMATION
Name of insured
*
Entity Type
*
Corporation
LLC
LLP
Individual/DBA
Non-Profit
Applicant's Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
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Ohio
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Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
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Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
UNDERWRITING INFORMATION
Describe your business operations:
How many years has the business been in operation?
What is the estimated number of events you have planned for the year?
Do any events include any of the following:
stunts
pyrotechnics
aircrafts
car races or precision driving
mechanical amusement devices
film production
live hip/hop, rap or metal music performances
any other hazardous activities
Please check all that apply.
If you checked "any other hazardous activities" above, please describe.
Do you have any private armed security (i.e. armed security that work exclusively for you under your employ)?
Yes
No
Any event with bounce houses or inflatables?
Yes
No
Please confirm you are obtaining a certificate of insurance from the entity providing them.
*
Confirm
Are you looking for a policy that would:
allow you to add events as you go
or one that would cover only the events you have scheduled for the year at this time?
What date would you like the coverage to start?
Month
Day
Year
What is the square footage of your office space?
What is the business' annual gross revenue?
How many employees do you have?
What is the average number of attendees for your events?
What is the maximum number of attendees for your events?
Have you ever had event insurance before?
Yes
No
If so, please provide the type of policy that was purchased (General Liability, Inland Marine, Automobile, etc.), the Carrier that provided the policy, the policy number, its expiration date and the price you paid (the premium) for the policy.
If you have had event insurance before, have you incurred any losses in the past three years? If yes, please explain.
LIABILITY COVERAGE OPTIONS
General Liability
1M/1M
1M/2M
1M/3M
2M/2M
3M/3M
4M/4M
5M/5M
Choose One.
Hired & Non-Owned Auto Liability
Exclude
Include
Include + Physical Damage
HNOA covers vehicles not owned by you that cause bodily or property damage while conducting business operations on your behalf. It is excess, meaning that if a vehicle has coverage on it, that insurance pays first. The Physical Damage is the coverage for the vehicle itself, and is normally required when renting vehicles.
Is coverage required for vendors/performers?
Exclude
Include
Liquor Liability
Exclude
Include
Host Liquor
Liquor Liability covers the SALE and/or SERVING of alcohol during an event (a liquor license might be required based on the state law). Host Liquor covers the lawsuits from only the serving of alcohol not for profit, such as champagne toasts or if you provide a bottle of wine per table, etc.
Will there be an open bar?
Yes
No
What measures are in place to prevent the service of alcohol to minor and/or intoxicated persons?
INLAND MARINE COVERAGE OPTIONS
Third Party Property Damage
Excluded
$250,000
$500,000
$1,000,000
Third Party Property Damage covers damage to the permanent fixtures of a location that you are renting for your business operations, such as windows, floors, doors, etc.
Rented Equipment (Including Props/Sets/Wardrobe)
Excluded
$10,000
$25,000
$50,000
$100,000
$250,000
other
CAST/CREW COVERAGE OPTIONS
Workers Compensation
Exclude
Include
Workers compensation covers the cast and crew for injuries while working. It meets the state requirements for coverage if it is available in your state. You can also obtain this from a payroll service in most cases.
Accident/Medical Coverage
Exclude
$10,000 per claim
$25,000 per claim
$50,000 per claim
Accident/Medical provides reimbursement for medical treatment during the production. It is NOT worker's compensation and does NOT meet state requirements for Worker's Compensation insurance. This is simply a layer of protection for cast and crew for those not purchasing worker's compensation.
Comments
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