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Entertainment - DICE/Annual Production Application
Entertainment - DICE/Annual Production Application
Get started by filling out this form and someone from our team will contact you shortly!
Entertainment - DICE/Annual Production Application
" * " indicates required fields
Name
This field is for validation purposes and should be left unchanged.
AS A GENERAL RULE OF THUMB: When inputting numbers and percentages, DON'T use special characters like $ or %
CUSTOMER INFORMATION
What type of entity is this insurance going to be for?
*
Choose One
Corporation
Individual or DBA
L.L.C.
Non-Profit
Partnership
Other
Please explain your "other" designation:
*
What is the name of the individual or entity this policy will cover (also known as the Named Insured)?
*
If you do not have a company, the name on the policy needs to match the name you are using for your vendors, permit offices or any other contracts/agreements you will be signing.
Do you have any DBAs that you operate under?
*
No
Yes
DBA stands for "Doing Business As". If you have not established your company as an official LLC, corporation, partnership or non-profit, a DBA is the "company" name that you use for business purposes. For example: John Smith DBA One Way Productions. A corporation or other type of company can also have DBAs.
Please advise the name/s of the DBA/s.
*
Please provide the name(s) of the production's/company's owner(s):
*
Physical Address (No PO Boxes or Foreign Addresses)
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have a different mailing address?
*
Yes
No
Mailing Address (No Foreign Addresses)
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Does your production company have a Web site?
*
Yes
No
Please provide a link to your production company's Web site:
*
You have to input the https:// to start your Web address, otherwise, you won't be able to proceed to the next page
What year did you start this business?
*
Contact Person
*
First
Last
Phone
*
Email
*
Enter Email
Confirm Email
Has this company/individual ever had film production insurance before?
*
Yes
No
Please provide the policy numbers, premiums and expiration dates of your prior insurance:
*
Have you ever had to file a claim against your production insurance before?
*
Yes
No
Regarding prior claims: please provide the date/s the claim/s happened, amount/s paid out to settle the claim/s and a description of the circumstances that caused the claim/s:
*
Can you provide loss runs from your prior/current coverage?
*
Yes
No
I don't have them now, but I can get them
The loss runs we're requesting are specific to film production coverage. Please don't supply us with loss history relevant to things like your house, car or health insurance. You can obtain loss runs from the agent/broker/carrier who provided you with coverage in the past.
Please upload loss runs here:
*
Max. file size: 50 MB.
Please advise why this individual/company has never had film production coverage before.
*
Please advise the names of your 3 biggest clients
*
If you do not currently have any clients, please say as such.
Name 3 productions that the proposed named insured has completed recently.
*
If the company has never produced any content before, please say as such.
How many productions did the proposed named insured complete last year?
*
Please enter a number from
0
to
1000000
.
Provide the following details of a least three (3) productions you plan to shoot within the next year: name of the production; dates of production; production budget; and production synopsis:
*
PRODUCTION INFORMATION
Total Annual Budget For All Productions Combined
*
This is your Gross Production Cost, or GPC
Maximum budget for a single production
*
Maximum number of days for a single production
*
Types of Productions you will shoot (select all that apply):
*
Feature Films
Short Films
Music Videos
Commercials
Documentaries
Industrial/Corporate
Educational
Trailers/Promos/Sizzle Reels/Proof of Concept Videos
TV Series
Reality Shows
Webisodes/Internet Productions/Social Media Content
Animation
Live Events
Please note: feature films and reality shows require special consideration.
For each type of production you selected above, please advise how many of each type of production you anticipate shooting over the next year:
*
I.e: feature films - 4; short films - 3; music videos - 10
Do you have any employees?
*
Yes
No
Employees are workers who receive a W-2 from you during tax season.
How many employees do you have?
*
What is the anticipated annual payroll for employees that you hire?
*
Will you be hiring any contractors or sub-contractors?
*
Yes
No
Contractors are people who are issued 1099s for the work they do for you.
How many contractors/sub-contractors do you hire to do work for you annually?
*
What kind of work will you be hiring contractors/sub-contractors to do?
*
What is the anticipated amount of money you will pay contractors/sub-contractors annually?
*
Do any contractors/sub-contractors you hire have their own insurance?
*
Yes
No
I don't know, but I suppose it's possible some would
Do you require such contractors/sub-contractors name you/your company as additional insured and provide evidence of their own workers compensation coverage?
*
Yes
No
You absolutely SHOULD be asking contractors and sub-contractors to provide evidence of their own work comp and name you as additional insured to their commercial general liability policies in order to fully protect your interests (if they are insured themselves) - especially if they're executing specialized work, like set construction.
Please confirm your understanding of the fact that you should be asking any contractors/sub-contractors that have their own insurance to provide you with evidence of their work comp and name you as additional insured to their own general liability coverage. Contractors/sub-contractors who don't have their own insurance are essentially considered "your employees" when they work for you.
*
Confirmed, I understand
I don't really understand - but I'll do a google/A.I. search or ask you about this later
Do you rent out equipment to others?
*
Yes
No
Please confirm your understanding of the fact that rental operations would need to be covered under a separate policy:
*
Confirmed, understood
Do you do any post production, editing or special effects work?
*
Yes, for others and for my own productions
Yes, but just for my own productions
Yes, but only for others
No
Please describe the type of post production, editing and special effects work you do.
*
What is the anticipated annual revenue for post production, editing and special effects work you do for others?
*
What percent of your work is post production, editing and special effects work you do for others?
*
Just type a number - don't include the % symbol - it confuses the form.
Please provide a list of the cities and states in which you anticipate shooting.
*
Do you plan to use DRONES during any of your productions?
*
Yes
No
Please seclect all options that describe how you will be executing drone activities:
*
We will be operating our own drones.
We will be operating drones that will be rented or borrowed from others.
We will be hiring drone operators who will be using their own drones.
We will be hiring drone operators; but the production will rent drones for the operators' use.
Will your drone operators be FAA certified, have their own UAV (unmanned aerial vehicle) policy, and be willing/able to name you as additional insured on their policy?
*
Yes
No
Please note: if your drone operators are able to name you as additional insured on their UAV policy, this will ensure that their policy will provide for your defense in court, should you be pulled into a lawsuit due to their drone activities.
Please confirm your understanding of the fact that this policy will NOT cover the damage/destruction of drones or damage/destruction of equipment harnessed to drones:
*
Confirmed, understood
Please confirm your understanding of the fact that drone activities must be scheduled to coverage in order to qualify for liability coverage - you can supply the information as it's known:
*
Confirmed, understood
QUALIFICATION QUESTIONS
Do you plan to shoot outdoors?
*
Yes
No
Will you be producing content for other people exclusively; or do you plan to produce your own short films, documentaries, etc.?
*
I am strictly in the business of producing content for others.
I will be producing my own short films, features, documentaries, etc.
I work for others and produce my own projects.
Any hard-core or soft-core pornography or live gangster rap music?
*
Yes
No
Will you be filming at locations that have any unprotected or open heights above 10 feet?
*
Yes
No
These are areas such as the edges of cliffs/mountains, on ledges of buildings or bridges, or on rooftops of buildings that have no walls/barriers. PLEASE NOTE: answering "yes" to this question will preclude our ability to quote worker's compensation.
Any employees supplied to or from an employee leasing operation? (i.e. PEO)
*
Yes
No
Will any of your productions include any stunts, jumps, falls, fight scenes, pyrotechnics, fireworks, wire work, aircraft, boats, trains, railroads, military equipment, race tracks/courses, helicopters, hot air baloons, motorbikes, snowmobiles, ATVs, blanks, squibs, guns (whether they're blank-firing or non-firing), weapons (such as knives, swords, clubs, etc.) or other hazardous activities?
*
Yes
No
Please confirm your understanding that these activities are considered stunts and would need to be scheduled once the details of the activitites are known.
*
Confirmed, I understand
Will you be shooting on or in bodies of water during production (i.e.: pools, lakes, rivers, oceans, hot springs, etc.)?
*
Yes
No
Please confirm your understanding that these activities are considered stunts and would need to be scheduled once the details of the activitites are known.
*
Confirmed, I understand
Will you be filming moving vehicles in any of the productions?
*
Yes
No
Will there be any racing, speeding, swerving, skidding, vehicle collisions or vehicle explosions that you're planning to execute?
*
Yes
No
Please confirm your understanding that these activities are considered stunts and would need to be scheduled once the details of the activitites are known.
*
Confirmed, I understand
Will domesticated animals be used in any productions?
*
Yes
No
Domesticated animals are pets - like dogs, cats and birds.
Please confirm your understanding that these activities are considered stunts and would need to be scheduled once the details of the activitites are known.
*
Confirmed, I understand
Will you be filming any farm or wild animals in any productions (i.e. horses, goats, pigs, tigers, lions, bears, etc.)?
*
Yes
No
Please confirm your understanding that these activities are considered stunts and would need to be scheduled once the details of the activitites are known.
*
Confirmed, I understand
Do you plan on entering into any co-production activities?
*
YES
NO
Co-production activities refer to collaborations with other production companies to execute a project.
Please advise the nature of the co-production activities, and the extent/nature of the co-productions you plan to enter into.
*
Please confirm that you will obtain a certificate of insurance from the other production companies you enter into co-productions with that names you as additional insured to their general liability coverage:
*
Confirmed
I'm not sure what this means, but I will ask you about it later
COVERAGE OPTIONS
General Liability
*
Choose One
Excluded
$1,000,000/$1,000,000
$1,000,000/$2,000,000
General Liability Medical Payment
*
Include
Exclude
THIS WILL NOT COVER INJURY TO CAST AND CREW. It essentially provides a bit of "go away" money to members of the general public who incur minor injuries due to a production's fault or negligence. It is employed by insurance carriers in the hopes that the claimant won't sue or continue with a lawsuit.
Do you need a Waiver of Subrogation?
*
Yes
No
This is not common and incurs an additional premium. A WOS prevents your insurance provider from trying to recoup money from an additional insured's insurance provider in the event that a claim is paid out on your policy.
Do you need Primary Wording?
*
Yes
No
This is not common and will incur an additional premium. Normally only required when a location or permit office require it.
Will you need to name a payroll company as additional insured?
*
Yes
No
Please advise the name of your payroll company:
*
Will you need to name any cities, states or government entities as additional insured on the policy?
*
Yes
No
Excess Liability
*
Choose One
Excluded
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
This is ADDITIONAL limits of liability bolsters the primary limits of liability. Unless someone is requiring you to have limits of general or auto liability that are higher than $1 million, you don't need this.
AUTO COVERAGE
Do you plan to rent or borrow any vehicles to execute your productions?
*
Yes
No
Would you need Auto Liability to satisfy the requirements of a film permit office, shoot location or other additional insured?
*
Yes
No
Will you be relying on people you hire (like production assistants) to use their own vehicles to execute production tasks and errands?
*
Yes
No
This is considered "borrowing" vehicles - and we would highly recommend that if you have this exposure, you consider adding, at very least, hired & non-owned liability coverage.
Hired and Non-Owned Auto Liability
*
Excluded
$1,000,000
This covers auto liability for any vehicle that is not owned by the Named Insured for bodily and property damage. This does not cover damage to the vehicle itself.
Will you need the policy to cover damage to rented or borrowed vehicles?
*
Yes
No
Hired and Non-Owned Auto Physical Damage
*
$125,000/$500,000
$250,000/$500,000
If you need the policy to cover the rented/borrowed vehicles themselves - you want this coverage. If you rent a vehicle, and it's damaged/destroyed while it's in your care, custody and control, this is the coverage you want to have to take care of the cost to repair/replace the vehicle.
How many production vehicles do you plan to rent/borrow annually?
*
Production vehicles include grip/lighting/equipment trucks, mobile studios. camera cars/process trailers, generator trucks, makeup/wardrobe/dressing room trailers, etc.
What is the total estimated annual cost of renting production vehicles?
*
How many other types of vehicles do you plan to rent/borrow annually?
*
This would be smaller passenger vehicles and vans (capable of seating less than 12 people) used to transport equipment, cast and crew.
What is the total estimated annual cost of renting other vehicles?
*
What is the estimated number of days you will be renting vehicles annually?
*
Do you plan to rent or borrow any 12-or-more passenger vehicles, buses or vans for the PRIMARY PURPOSE of transporting people?
*
Yes
No
Please confirm your understanding of the fact that in order for coverage to apply when you're using 12-or-more passenger vehicles for the PRIMARY PURPOSE of transporting people, the drivers of such vehicles will need to be scheduled to the policy. You will need to send us a copy of the drivers' licenses of these individuals so we can ensure they have an acceptable Motor Vehicle Report history.
*
Confirmed, I understand
I don't understand, but I will ask you about this later
INLAND MARINE COVERAGE
Rented Equipment
*
Excluded
$100,000
$150,000
$200,000
$250,000
$300,000
$400,000
$500,000
$750,000
$1,000,000
Other
Rented Equipment covers equipment that is NOT owned by the Named Insured. It is equipment that the production rents or borrows from others (such as rental houses, directors of photography, cinematographers, etc.). Rented Equipment covers grip, lighting, cameras, lenses and other equipment used for production that is not a prop, set or wardrobe.
Please advise the "other" limit of coverage you'd like to be quoted for:
*
Please confirm your understanding of the fact that in order for coverage to apply for equipment you rent from others (whether that be a rental house, DP, grip, etc.) there needs to be a signed contract in place between yourself and the individual/entity that is expecting your policy to cover their equipment:
*
Confirmed, I understand
I don't understand, but I'll ask you about this later
If a claim should arise, the insurance adjuster who makes the decision as to whether the policy will afford you with coverage will want to see that there is a written contract in place between you and whomever was allowing you to use their equipment. It's important.
Owned Equipment
*
Excluded
Included
Owned equipment covers film production equipment that is owned by the named insured on the policy.
What is the replacement value of the equipment you own?
*
Can you supply a schedule of the equipment you own?
*
Yes
No
I can, but not right now
If you're able to supply a schedule of the equipment you want the policy to cover, it'll save you a little bit of money. The schedule MUST reflect the make, model, serial number (if applicable) and replacement cost of each item you'd like the policy to cover.
Please upload your equipment schedule
*
Max. file size: 50 MB.
Please advise the address where the Owned Equipment is stored:
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Please advise what kind of security features are present at the location where your equipment is stored (select all that apply):
*
Dead Bolts
Centrally Monitored Burglar Alarm
Local Alarm
Video Surveillance
Fenced/Gated Property
Security Patrol (not a neighborhood watch - an actual guard who's paid to watch YOUR location)
Select All
What is the name of the company that supplies your centrally monitored burglar alarm?
*
Props/Sets/Wardrobes
*
Excluded
$75,000
$100,000
$150,000
$200,000
$250,000
$300,000
$400,000
$500,000
$750,000
$1,000,000
Other
Props, sets and wardrobe covers things like clothing, shoes, furniture, rugs, knick-knacks, and other things at your shoot locations that aren't a part of the actual structure of the building. If you would need coverage for high-dollar art and expensive jewelry and furs, that would be a separate concern.
Please select the deductible for your equipment/props.
*
$500
$1,000
$2,500
We will try to accommodate your requested deductible; however, certain underwriters do not provide options for deductibles. Please be sure to look over your quote so that you are aware of the deductible that is being offered for coverage.
Negative Film, Faulty Stock and Dititized Image
*
Excluded
Include
This provides coverage against direct physical loss, damage, or destruction of digital media, raw film or tape stock, exposed film (developed or undeveloped), recording videotape, sound tracks and tapes, and loss due to faulty equipment, development, editing, processing or accidental erasure of recording up to the amount of the insured production cost. Not all carriers offer this coverage.
What percentage of your GPC (Gross Production Cost) would you like the negative film/faulty stock/digitized image coverage to cover?
*
100%
75%
50%
25%
The higher the percentage is, the more expensive the cost of coverage will be.
Third Party Property Damage
*
Excluded
$250,000
$500,000
$1,000,000
$2,000,000
Third party property damage covers damages to permanent structures of locations (i.e. walls, doors, railings, windows, floors, etc.). It would not provide coverage for things like furniture, decorations, rugs, window dressings or other things at a location that might not be a part of the permanent structure of the building. If you need that kind of coverage, please request props, sets and wardrobe coverage.
Extra Expense
*
Excluded
$10,000
$25,000
$50,000
$100,000
$250,000
Extra Expense covers the additional costs you incur to continue production in the event of a covered cause of loss (i.e. a rented camera breaks and you have to source a new one)
Office Contents
*
Excluded
$10,000
$25,000
Cast Extra Expense
*
Exclude
100% of Gross Production Cost
75% of Gross Production Cost
50% of Gross Production Cost
25% of Gross Production Cost
Please Note: This would provide coverage for extra expenses incurred by the production due to the absence of cast or crew members because of death, disability (accident or sickness) or kidnapping. Cast coverage provides protection from pre-production through production and post-production. All cast and crew must be scheduled in advance and medical exams are required for sickness coverage. For coverage on an unscheduled basis, you may request the 'covered person extension WITH or WITHOUT sickness coverage'.
Scheduled or Unscheduled Cast Coverage
*
I would like to schedule the cast and crew members that I want the Cast Coverage for. I understand that in order for coverage to be offered in instances where a cast or crew member becomes ill, a medical exam of that individual would have to be performed and submitted to the underwriter BEFORE a claim is made. (Incurs no additional premium)
I would like to request a 'covered person extension WITH sickness coverage' that would allow all cast and crew to be covered in the event of illness, death, injury or kidnapping without having to schedule each individual for coverage. I understand that medical exams of the cast and crew would have to be performed and submitted to the underwriter BEFORE a claim is made, in order for sickness coverage to apply. (Additional premium would apply)
I would like to request a 'covered person extension WITHOUT sickness coverage' that would allow all cast and crew to be covered in the event of death, injury or kidnapping without having to schedule each individual for coverage. Coverage for sickness can still be offered; however the individuals who would be covered for sickness would need to be scheduled for coverage, and a medical exam of the individuals would have to be performed and submitted to the underwriter BEFORE a claim is made. (Additional premium would apply)
Please note: THIS DOES NOT PROVIDE COVERAGE FOR ON-SET INJURY TO CAST AND CREW.
We will need the following information to schedule the cast and crew: 1. First and last name of the cast or crew member 2. The cast person's character's name or the crew member's job title 3. Their date of birth 4. Their start date on production. 5. Their end date on production.
*
Please note: THIS DOES NOT PROVIDE COVERAGE FOR ON-SET INJURY TO CAST AND CREW.
Family Bereavement
*
Exclude
Include
Expands cast coverage to provide for a bereavement period up to 5 days due to the death of an immediate family member.
Animal Extra Expense
*
Exclude
$10,000
$20,000
$30,000
$40,000
$50,000
Provides reimbursement for extra expenses incurred should an animal that is being used by the production not be able to fulfill its commitment. Please note: This would not provide a payout for an animal whose death, illness or injury is attributable to the production. That type of coverage cannot be provided on a blanket basis. If it is needed, we would need to schedule specific animals for coverage. That information can be submitted on an as-known basis.
COVERAGE FOR INJURY TO CAST AND CREW
Do you need/want to be quoted for workers compensation?
*
Yes
No
Worker's compensation covers the cast and crew for illness, injury, death or dismemberment that is attributable to working on a production. It will also provide for your defense in court should an employee, contractor or family of such workers sue you in relation to an illness, injury, death or dismemberment that occurred on set.
Which of the following pieces of information would you like to supply so we can provide a quote that includes worker's compensation?
*
Tax ID Number
Name and Social Security Number of an officer/owner
A tax ID number is required if you're looking to bind coverage for an LLC, LLP, Non-Profit or Corporation. Social security numbers are only acceptable for coverage being bound to cover Individuals/DBAs.
Tax ID Number
*
Name of owner/officer
*
Social Security Number of owner/officer
*
Would you like to include or exclude the owners/officers/members/managing members of the production company in the work comp coverage?
*
Include
Exclude
PLEASE NOTE: Including owners/operators/officers in the worker's compensation coverage will increase the cost of coverage.
Please provide the following information for each managing member/owner/operator/officer you would like the work comp policy to cover: 1. Name 2. Title (i.e. Member, Managing Member, CEO, CFO, Secretary, Treasurer, etc.) 3. Annual salary:
*
How many cast/crew members will you need the work comp policy to cover?
*
The figure you supply here should include the payroll for employees, contractors and sub-contractors you would want the policy to cover.
What is the anticipated annual payroll for all cast and crew?
*
The figure you supply here should include the payroll for employees, contractors and sub-contractors you would want the policy to cover.
Do you want to be quoted for a more simple/less expensive policy that would only supply a modicum of coverage for medical bills in case of on-set injury?
*
Yes
No
Accident/Medical Coverage
*
$25,000 Per claim per person
$50,000 Per claim per person
$100,000 Per claim per person
Other
Accident/Medical covers medical expenses attributable to on-set injury, death or dismemberment. It does NOT cover claims related to illness. Accident Medical coverage cannot be offered if you have worker's compensation in place. It is typically NOT an acceptable substitute for worker's compensation. So, if you're being required to have worker's compensation, we would recommend that you clear it with whomever is requiring you to have workers compensation before relying on this kind of policy to cover your interests.
Please advise "other" limit of coverage you'd like to be quoted for:
*
What is the maximum number of cast and crew you'll have on set at any one time?
*
Please enter a number from
1
to
2000
.
Will you be paying cast and crew for their performances/services?
*
Yes
No
Sometimes
Please confirm that you do not/will not have a worker's compensation policy in place.
*
Confirmed
We cannot offer accident medical if you already have workers compensation coverage in place.
OTHER INFORMATION
As of what date would you like this policy to start?
*
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