General Information Business Type* Contact Address (you/your organization)*
***Must have a United States address to be eligible for coverage (events taking place internationally can still be considered as long as policy holder is domiciled in the US)
Event #1 Event #1 - Role in relation to event* Which of these options best describes your role at the event you are seeking coverage for?
Event #1 - Is the event location in the United States?* Event #1 - Venue Address*
Physical address of where the event is taking place, not your contact address or address of the additional insured entity you need listed
Event #1 - Venue Address*
Physical address of where the event is taking place, not your contact address or address of the additional insured entity you need listed
Event #1 - Venue Address*
Physical address of where the event is taking place, not your contact address or address of the additional insured entity you need listed
Do you need to add a second location/venue or a second event that will be taking place on a different date?*
Event #2 Event #2 - Role in relation to event* Which of these options best describes your role at the event you are seeking coverage for?
Event #2 - Is the event location in the United States?* Event #2 - Venue Address*
Event #2 - Venue Address*
Event #2 - Venue Address*
Are any other venues / locations being used for the event that coverage needs to extend to?*
Film / Photography Questions Will your production occur 100% inside a studio?* Does your production involve any stunts, fight scenes, scenes involving drones, moving vehicles, open flames, pyrotechnics and/ or other hazardous activities?* Will your photographer / videographer duties include any drone use or equipment installed into the venue?*
Bartender Questions Are you the sole alcohol vendor / bartender at the event?* Will be alcohol be served by Licensed bartender(s)?* Will total alcohol sales / proceeds associated with this event exceed $5,000?* Have you ever suffered a liquor liability related loss?*
Road Race / Walk-a-thon Questions Will each intersection and road crossing be 100% controlled by the police?* Are you taking proper safety precautions by posting signage along race route and using cones to separate runners from traffic and the general public?*
Food Vendor / Catering Service Questions Will the food be prepared on or off site?* Will food be prepared 100% outdoors?* Please confirm there will be precautions in place to keep attendees a safe distance from cooking equipment/open flames (i.e table barrier).* Please confirm necessary steps are taken to prevent food spoliation.* Please confirm you will not be serving any raw meats or easily perishable foods.* Will you be selling / serving alcohol?* Will be alcohol be served by Licensed bartender(s)?* Will total alcohol sales / proceeds associated with this event exceed $5,000?* Have you ever suffered a liquor liability related loss?*
Block Party / Street Closure Event Questions Will the street be closed off via permit with the city?* Will the event area be properly secured and separated from traffic with appropriate barriers?*
Performer / Entertainer Questions Will your performance include any pyrotechnics, open flames, paint, foam, bubbles, stage diving, items thrown into the crowd, props (fog machines etc) or elevated speakers?*
Parade Questions Will there be floats in the parade?* Are all floats operated by a 3rd party entities with their own insurance naming you/your organization as additional insured?* Will there be vehicles in the parade?* Do you verify the drivers carry auto insurance that meets the state minimums?* Please confirm no objects will be thrown into the crowd* Please confirm there are precautions in place to keep spectators a safe distance from the parade* Will there be any live animals in the parade?*
Florist Questions Will you be responsible for any elevated displays or installations into the venue (e.g., nailing, screwing, etc.)?*
Car Show Questions Will all display vehicles remain 100% static and disabled throughout the entire event?* Will all display vehicles be parked on pavement?*
Fishing Event Questions Which of the following best describes the aspect of the event that you are seeking coverage for?* Will participants be using boats on water? Or will the fishing be 100% shore casting?*
Political Event Questions Will the event take place 100% indoors?* Is the event open to the public? Or invite only?* Will the event feature any marches, rallies, demonstrations or similar activities?*
General Underwriting Questions Do all participants / legal guardians of minor participants sign waivers holding your organization harmless?* Are you seeking a quote with athletic participant coverage (excess medical, participant liability), or just general liability to meet contractual requirements, excluding athletic participant injury coverage?* Are any of the covered activities taking place at a private residence or house rental property (i.e. Air BnB, VRBO or similar)?* Is the event taking place indoors or outdoors?* Will there be any live music or entertainment at your event?* Will there be any mosh pits, slam dancing, crowd surfing or similar activities taking place at your event?* Who is responsible for security?* Does the 3rd party security company carry their own liability insurance and name you/your organization as additional insured?* Will there be any ARMED private security at the event? **ineligible if yes*** Please confirm your activities will not include any of the following: Activities taking place in or on water, Cannabis (including but not limited to edibles, CBD, etc), Hot Air Balloons, Tough Man Competitions/Iron Man Competitions, Fireworks / Pyrotechnics, Laser taG, Motorsports, Aircraft, Food with open flames, Hypnotist/magicians, Fireworks, Child care operations, Inflatables, Mechanical amusement rides, Firearms, Knives, Live animals, Hayrides, Trail rides, Rodeos, roping activities, Saddle Animals, Tractor pulls, Tattoo/body piercing, Direct contact with spectators/attendees (referring to hands on services such as massage therapy, Parades/parade participation, Paintball, Temporary ice skating rinks, Skiing, Skateboarding, Luge, Rock climbing walls, Velcro Jumps, Extreme sports, Tobogganing, Snow Skiing, Hang Gliding, Skydiving Diving, Snowmobiling, Trampolines, Parachuting, Bungee Jumping, Driver's Education, Evangelistic Meetings with Faith Healing activities, Go Kart Races, War Games/Re-enactments, Reality TV shows, Camping, Swimming pool or open water swimming activities* Please confirm your activities will not include any of the following: Activities taking place in or on water, Cannabis (including but not limited to edibles, CBD, etc), Hot Air Balloons, Tough Man Competitions/Iron Man Competitions, Fireworks / Pyrotechnics, Laser taG, Motorsports, Aircraft, Food with open flames, Hypnotist/magicians, Fireworks, Child care operations, Inflatables, Mechanical amusement rides, Firearms, Knives, Live animals, Hayrides, Trail rides, Rodeos, roping activities, Saddle Animals, Tractor pulls, Tattoo/body piercing, Direct contact with spectators/attendees (referring to hands on services such as massage therapy, Parades/parade participation, Paintball, Temporary ice skating rinks, Skiing, Skateboarding, Luge, Rock climbing walls, Velcro Jumps, Extreme sports, Tobogganing, Snow Skiing, Hang Gliding, Skydiving Diving, Snowmobiling, Trampolines, Parachuting, Bungee Jumping, Driver's Education, Evangelistic Meetings with Faith Healing activities, Go Kart Races, War Games/Re-enactments, Reality TV shows, Camping, Swimming pool or open water swimming activities* Please confirm your activities will not include any of the following: Acts taking place at a Circus, Tobacco products, electronic cigarettes, hookah, vape products, Drones, Food with open Flames, Aviation vendors, Bartending / the sale or serving of alcohol, Beautician, skincare, hairdresser, makeup artist, Childcare Operations, Equipment installation (lighting, rigging, AV systems, temporary structures etc), Event decoration/setup services, Fireworks, Pyrotechnics, Hands on services (massage therapy, acupuncture etc), Hypnotist/Magicians, Medical services including but not limited to health screenings, vaccinations and testing, Paintball, airsoft, Live Animals, Petting Zoos, Pony Rides, Product demonstrations involving power tools/heavy machinery, Remote control race cars, Santa Claus/mascots/any other character or impersonator, Security services, Firearms, Knives or any other weapons, Setting up any type of temporary structures (not including tents size 10 ft x 10 ft or less), Tattoo or Body Piercing, Driver's Education, Test drives and/or ride and drive activities, Cannabis (including but not limited to edibles, CBD, etc), Inflatables, Mechanical amusement rides, rock climbing walls, bungee jumping, trampolines, water slides, ropes course, Hayrides, Trail rides, Tractor pulls, Parade participation, Golf Carts* Please confirm your activities will not include any of the following: Acts taking place at a Circus, Tobacco products, electronic cigarettes, hookah, vape products, Drones, Food with open Flames, Aviation vendors, Beautician, skincare, hairdresser, makeup artist, Childcare Operations, Equipment installation (lighting, rigging, AV systems, temporary structures etc), Event decoration/setup services, Fireworks, Pyrotechnics, Hands on services (massage therapy, acupuncture etc), Hypnotist/Magicians, Medical services including but not limited to health screenings, vaccinations and testing, Paintball, airsoft, Live Animals, Petting Zoos, Pony Rides, Product demonstrations involving power tools/heavy machinery, Remote control race cars, Santa Claus/mascots/any other character or impersonator, Security services, Firearms, Knives or any other weapons, Setting up any type of temporary structures (not including tents size 10 ft x 10 ft or less), Tattoo or Body Piercing, Driver's Education, Test drives and/or ride and drive activities, Cannabis (including but not limited to edibles, CBD, etc), Inflatables, Mechanical amusement rides, rock climbing walls, bungee jumping, trampolines, water slides, ropes course, Hayrides, Trail rides, Tractor pulls, Parade participation, Golf Carts* Please confirm your activities will not include any of the following Acts taking place at a Circus, Tobacco products, electronic cigarettes, hookah, vape products, Drones, Food with open Flames, Aviation vendors, Bartending / the sale or serving of alcohol, Beautician, skincare, hairdresser, makeup artist, Childcare Operations, Event decoration/setup services, Fireworks, Pyrotechnics, Hands on services (massage therapy, acupuncture etc), Hypnotist/Magicians, Medical services including but not limited to health screenings, vaccinations and testing, Paintball, airsoft, Live Animals, Petting Zoos, Pony Rides, Product demonstrations involving power tools/heavy machinery, Remote control race cars, Santa Claus/mascots/any other character or impersonator, Security services, Firearms, Knives or any other weapons, , Tattoo or Body Piercing, Driver's Education, Test drives and/or ride and drive activities, Cannabis (including but not limited to edibles, CBD, etc), Inflatables, Mechanical amusement rides, rock climbing walls, bungee jumping, trampolines, water slides, ropes course, Hayrides, Trail rides, Tractor pulls, Parade participation, Golf Carts* Will there be any event activities taking place after 2:00 AM?* Will attendees be sleeping overnight at the venue address(es) shown on this application?* Do you have any prior insurance claims/losses or pending incidents which could result in a future claim?*
Liquor Liability Questions Will attendees be consuming alcohol at your event?* Which of the following best describes how alcohol will be served/consumed?* Will be alcohol be served by licensed bartender(s)?* Will total alcohol sales / proceeds associated with this event exceed $5,000?* Have you ever suffered a liquor liability related loss?*
Additional Insured / Insurance Requirement Details Do you need to include a specific entity as addititional insured on the policy to satisfy contractual requirements?* Manager / lessor of event location, city/municipality, school district / school board etc
Additional Insured #1 Address*
Do you need to add another additional insured entity?* Additional Insured #2 Address*
Do you need to add any other additional insured entities?* Are there any specific general liability limits, umbrella/excess liability limits or any other specific coverages that you are being required to carry?*
Comments / Additional Remarks 