Special Events Insurance Application

Quick Submission for Commercial Accounts

To ensure fast service for your commercial account related to special events, please complete the form below and submit it. Your submission will be electronically forwarded to the next available commercial lines underwriter for prompt processing.

Name of Your Company/ Organization

Entity Type (Indiv, Corp. LLC, etc)

Mailing Address (P.O Box- okay)

Contact person

E-mail Address

How much experience do you have at operating this type of event?

Any: Stunts, Pyrotechnics, Aircraft, Hazardous Activities, Car Races,Precision Driving, Mechanical Devices, Film Production, Rap/Hip-Hop, Rock/Metal,Rides, Water Activities

Auto (If property

The event will take place in the United States

Any armed private security guards

Any bounce houses or inflatables (If Yes, certificates of insurance are required)

Will your event occur in a bar or nightclub?

(Concert): Is there assigned seating?

Will there be temporary structures installed/built for your event?

Effective

Expiration

Load In/ Load Out dates

Do you want these rates included in your quote?

Yes
No
No data entered

Average Daily Spectators/Guests

Important for rating purposes

Average Daily participants: (volunteers, ushers, ticjet takers, athletes, performers, etc)

Important for rating purposes

Please describe participants and how many of each

Type of Event

Is there overnight stays/camping?

Event Name

Budget (Cost of Event)

Brief description of the Event

Venue Name

Location Information

Indoor
Outdoor
Both Indoor/Outdoor

Any Celebrities at the Event?

List of Celebrities (if any) at the Event

Type of Performance/Entertainment (DJ, Solo Artist, Live Music, Comedian)

Name of Performer/Entertainment

Type of music

Music Decade

Artist/Band Name

Do you require an additional insured certificate from the entertainers naming YOU as an additional insured on their insurance policy?

Yes
No
Not applicable

If not, there may be an additional premium charge of $135(minimum depending on the insurance market used to insure the band/performer with their own policy.

Do you hire any subcontractors for the insured event(s), (ie: caterers, bands/entertainment, lightning, sound, staging, decorations, security, etc)?

If Yes, Please describe

Do you require all subcontractors to have their own insurance and provide you with a Certificate of Insurance (COI) naming you as an Additional Insured (AI)

How many security personnel will be present?( if none, enter 0):

Please note that for higher risk events it may be required to have 1 security person per 100 attendees. If private security company is used, we will require a Certificate of Insurance.

Do you hire security?

Name of Security Company

On Duty Police Officers

Off-Duty Police Officers

Private Armed Security

Uninformed (unarmed) Security

T-shirt Security

Other

Do you have a metal detector at all entrances and exits that attendees and performers must pass through?

Yes
No
Not applicable

This will be required for higher risk events.

Waiver of Subrogation (only if required by contract): Include (checkbox) Exclude(checkbox)

Include
Exclude

1. What is the name of the entity requesting the waiver of subrogation?

2. What is their Involvement in the event?

Rented Equipment Limit

($5,000 minimum - $2,000,000 maximum)

Dates rented equipment will be in delivered

and returned

1a. Will rented portable equipment (i.e. lighting, sound, video, portable toilets, generators, forklifts, etc.)

Dollar replacement value required (you may have to ask the rental company for the values) $

1b. Will rented Furniture be used (i.e. dining tables, any kind of chairs, sofas, coffee tables, end tables, etc.)

Dollar replacement value required (you may have to ask the rental company for the values) $

1c. Will rented Fixtures be used (i.e. awnings, tents, etc.)

Dollar replacement value required (you may have to ask the rental company for the values) $

1d. Will rented Growing Plants be used (i.e. ficus trees /bushes, other types of potted plants be used as barriers or decoration)

Dollar replacement value required (you may have to ask the rental company for the values)

2. Will the property be stored overnight?

If Yes, please provide details on how it will be stored:

3. Will you be responsible for transporting the property?

If "Yes": Please describe how it is being transported

If "No": Name of who is transporting the property?

1. Who is transporting the property?

Yes
No
Not Applicable

Rental House

Yes
No
Not Applicable

Other

2. Is the company transporting the property naming you as an Additional Insured on their insurance policy?

Yes
No
Not Applicable

4. Will the property stay in your possession at all times prior to returning to rental company? Will it be secure?

Please explain

Liquor Liability ($1,000,000 Limit)

Include
Exclude

If included, Will alcohol be served by a Licensed bartender?

If No, Who will be serving the alcohol? (If none, enter: 0)

Describe the training and/or experience of persons serving alcohol

Average age of attendees: (If none, enter: 0)

What measures are in place to prevent the service of alcohol to minors and/or intoxicated persons?

(Wrist bands, stamped wrist, tickets with I.D. check, none, etc.)

Does the Applicant have a valid Liquor License?

If No, who has the liquor license?

(Please identify by name and if a caterer, restaurant, sponsor, event planner, none, etc.)

Please describe what kind of alcohol will be served

Beer
Wine
Cocktails

Other

Will there be an open bar?

Yes
No
Not Applicable

Will alcohol be sold by the drink?

Yes
No
Not Applicable

Is BYOB (bring your own bottle) allowed?

Yes
No
Not Applicable

Estimated alcohol gross receipts? (If none, enter: 0)

Hired & Non-Owned Auto Liability

Include
Exclude

($1,000,000) (Minimum premium $500)

Check here if you are required by contract to acquire Hired/Non-Owned Auto and you NOT being loaned, rented or leased any vehicles.

Checkbox

If checked, please provide a copy of the contract. If not, please complete the questions below

1. Amount being charged to rent or lease the vehicle(s)?

2. Are all drivers at least 25 years of age?

Yes
No
Not Applicable

3. Do all drivers have a valid United States drivers license?

Yes
No
Not Applicable

4. Do any of the hired vehicles seat more than 12 people?

Yes
No
Not Applicable

What will the vehicles be used for?

Event Cancellation (Minimum premium $250)

Include
Exclude

Participants Medical (Minimum premium $200)

Include
Exclude

Spectators Medical (Minimum premium $200)

Include
Exclude

Number of Exhibitors (no sales)

Concessionaires (non-food sales)

Concessionaires (food sales)

Performers and Attractions

Do you require all Vendors/Exhibitors to have their own liability insurance and provide you with a certificate of insurance naming you as an additional insured?

Yes
No
Not Applicable

WORKERS COMPENSATION

Include
Exclude

Waiver of Subrogation (only if required by contract)

Include
Exclude

If needed, please include contract with application

1. What is the name of the entity requesting the waiver of subrogation?

2. What is their involvement in the event?

Payroll Company Name (if any)

# Full-Time

# Part-Time

(W-2, 1099, Deferred, Other

(Please identify)

# Full-Time

# Part-Time

(W-2, 1099, Deferred, Other

(Please identify)

# Full-Time

# Part-Time

(W-2, 1099, Deferred, Other

(Please identify)

First Name

Last Name

Title/Position

ADDITIONAL COMMENTS

Insurance Agency Name

Agent Contact Person

Agent Contact Person Email