IMPORTANT: Please provide a US address. No PO Boxes.
Insured Name
Address
Address2
City
State
Zip
Country
Entity Type
Years Experience
Primary Contact
Last Name
First Name
E-mail
Phone
Fax
Other phone
Underwriting
Questions
a. Does the event include any Stunts,
Pyrotechnics, Aircrafts, Animals, Hazardous Activities,
Car Races, Precision Driving, Injury to Participants,
Mechanical Devices, Owned Equipment, Private Armed Security
Guards, Events outside U.S., Film Production, Earthquake,
Flood, Rap/Hip-Hop, Rock/Metal, Weather, Rides, Water
Activities
yes
no
b.. Any armed private security guards?
(i.e. armed security that works exclusively for you under your employ)
yes
no
c. Any event with bounce houses or inflatables? (if yes then certificates of insurance are required)
yes
no
2.
Claim History
Any prior event with any losses
of any kind declared by the insured and/or known by
the broker?
yes
no
Effective Date of Policy
Inland Marine
Third-Party Property Damage
Hired and Non-Owned Auto and Physical Damage (Occ.Agg)
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Paying by credit card? Click here for a credit card authorization form. Please print, and mail a signed copy to us. All insurance sales are non-cancellable and subject to a 3.5% surcharge.
