Entertainment – Errors & Omissions ApplicationAdmin2019-01-02T12:49:00-08:00 Get started by filling out this form and someone from our team will contact you shortly! Entertainment - Errors & Omissions Application Customer InformationWhat type of entity is this insurance going to be for?*Choose OneCorporationIndividual or DBAL.L.C.Non-ProfitPartnershipWhat is the name that the insurance will be under?*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 that you have.Address (No PO Boxes)* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person* First Last Phone*Email* Enter Email Confirm Email How many employees do you have?*Any prior insurance?*YesNoPlease provide the policy numbers, premiums and expiration dates of your prior insurance:*Any prior claims?*YesNoPlease provide the dates, amounts of the claim(s) and descriptions of what happened:*Any insurance declined, cancelled or non-renewed that provided the same or similar coverage as the insurance sought?*YesNoPlease provide an explanation.*Are you aware of any claims or legal proceedings made or commenced against You or any of Your officers, members, or partners within the last five (5) years for any invasion of privacy or false light, IP infringement, defamation; or breach of contract arising out of the alleged submission of any ideas, story line, or script?*YesNoPlease provide an explanation.*Does the production include any pornographic materials, ride alongs, hidden cameras, pranks and consumer voting or is it an animated theatrical release?*YesNoDo you have a U.S. based attorney with 5 years or more relevant entertainment insurance experience performing the clearances for this production?*YesNoAn attorney doing clearances allows us to provide quotes from a wider variety of companies at a lower cost. ***PLEASE NOTE THAT AN ATTORNEY IS REQUIRED FOR E&O IF YOU ARE BASED OUT OF NEW YORK, FLORIDA AND OTHER SPECIFIC STATES. ***If you are based out of New York, our carriers require that you have the production vetted by an attorney with 5 or more years of relevant entertainment law experience. We can quote it for you, anyway, but that is required to bind coverage. CLEARANCE INFORMATIONHave you obtained a title report for this production?*YesNoIs the name or likeness of any actual living person used, portrayed or identifiable in the Named Production?*YesNoDo you have the appropriate releases to use the footage with the identifiable living person?*YesNoPlease provide a description of the scenes with identifiable person(s)*Is the name or likeness of any actual deceased person used, portrayed or identifiable in the Named Production?*YesNoDo you have the appropriate releases to use the footage with the identifiable deceased person?*YesNoPlease provide a description of the scenes with identifiable person(s)*Is the production based on an underlying work?*YesNoPlease confirm the following by checking each box* You are not aware of any similar format or concept No similar format or material has been submitted to you at any time Please confirm the following by checking each box* Copyright reports have been obtained No ambiguities, gaps or problems in the chain of title The chain of title of all works on which the production is based has been thoroughly investigated and cleared back to the original copyright owners to determine that all grants or transfers in the chain of title permit you to assign or sublicense the material as incorporated in your production Have you obtained from all writers and other content providers to the production, written warranties that the content with which they provide you does not infringe the rights of any third party and have you obtained an indemnity for any breach of this warranty?*YesNoHave you obtained a written agreement from all performers or persons appearing in your production consenting to their appearance?*YesNoWill any film clips, TV clips or photographs be used in the productions?*YesNoHave all licenses and consents been obtained from the copyright owner without restriction and are you authorized to assign or sublicense the licensed materials as incorporated in your production?*YesNoHave the following musical rights been obtained from the composer and/or performers of specially commissioned music and/or cleared with the owners of pre-existing music and/or recordings, including: Recording and synchronization Performing rights? Right to distribute for all forms of distribution contemplated (home video, etc.)*YesNoDo you have the authorization of any person or entity depicted in the film clip, TV clip or photograph to use their depiction in your production and to assign or sublicense that depiction in your production?*YesNoHave you or any of your agents been unable to obtain or been refused an agreement or release after having: Negotiated for any rights in literary, musical or other materials? Negotiated for release from any persons in respect of any material incorporated in the production?*YesNoPlease explain why you were unable to obtain an agreement/release from the above.*Did you screen the Named Production for the following possible offenses?* Trademark Ingringement Copyright Infringement False Light Claim Defamation Privacy Violations Violation of rights of publicity None Were such screenings performed by, or under the supervision of, a qualified attorney?*YesNoIn the past three (3) years, have you been given notice of any potential infringement another party's intellectual property (IP) rights, including without limitation, copyright or trademark infringement?*Do your compliance procedures include any of the following:Training of employees regarding copyright, trademark, and defamation issues.*YesNoDo your requirements of freelancers, independent contractors, musicians, composers, or others who provide content include, statements to assign or license you their rights to the content?*YesNoDo your requirements of freelancers, independent contractors, musicians, composers, or others who provide content include a warrant that their work does not violate another party's rights?*YesNoDo your requirements of freelancers, independent contractors, musicians, composers, or others who provide content include Indemnification should an IP infringement claim be made against you?*YesNoDo your requirements of freelancers, independent contractors, musicians, composers, or others who provide content stating to hold you harmless should an IP infringement claim be made against you?*YesNoAcquisition of all necessary IP rights via licenses, consents, or releases.*YesNoTrademark searches by employees.*YesNoTrademark searches by professional search firm.*YesNoCopyright searches by employees.*YesNoCopyright searches by professional search firm.*YesNoClearance of performing, recording, and synchronization rights.*YesNoWere the requirements outlined above met with regards to the Insurance sought?*YesNoMERCHANDISING OPTIONSIs coverage desired for Merchandising for this Production?*YesNoHave all necessary consents and licenses been obtained in respect of any associated merchandising?*YesNoWill appropriate trademark or other searches be made before merchandising characters or other matter that might be subject to trademark, unfair competition or similar claims?*YesNoLEGAL PROCEDURESHave you suffered any loss or has any claim, whether successful or not, ever been made against you that would be covered by this insurance?*YesNoPlease provide details regarding any loss or claims*Are you aware of any problem which is likely to lead to you suffering a loss or a claim being made against you that would be covered by this insurance?*YesNoPlease provide details regarding any problems likely to result in a loss that you are aware of.*It is understood and agreed that with respect to the above questions if such knowledge of information exists, any claim or action arising there from is excluded from this proposed coverage*YesNo PRODUCTION INFORMATIONWhat is the exact title of the production?*Please choose the production type.*CommercialDocumentaryEducational VideoFeature (for theatrical release)Feature (not for theatrical release)IndustrialInfomercialMusic VideoOtherRadio Series (1 episode per week)Radio Series (2+ episodes per week)Reality TV (Scripted)Reality TV (Unscripted)Television Mini series or DocudramasTelevision Pilot, Feature or SpecialTelevision Series (Daily)Television Series (Weekly)Theatrical Stage PerformanceTraining VideoWhat type of music?*AlternativeBluesClassicChildren'sClassicalCountryElectronicFolkHard Rock/Heavy MetalHip-Hop/RapJazzLatinNew AgeOperahPopR&B/Soul (Other than Rap/Hip-Hop)RegaeRockWorldPlease choose the nature of the production.*Based On Another WorkContraversialEducationalForeign LanguageHome & GardenInnocousInvestigative ReportingLive ProgrammingReality TVTalk ShowWhat type of work is this?*Entirely fictional and originalEntirely fictional but based on another’s workEntirely fictional but inspired by actual eventsPortrayal of actual events with original fictionalizationTrue portrayal of actual eventsOtherName of Author(s):*Title(s):*Date(s) of Publication:*What is the budget of the production?*Numbers only, no dollar signs. We will need a budget top sheet that matches this number exactly.How many minutes is this production?*Production Synopsis*Please provide a short plot outline of the production.Anticipated Release Date* Date Format: MM slash DD slash YYYY How many episodes are there?*How many minutes are each episode?*DISTRIBUTION INFORMATIONHow will this production be distributed?*Local - 90% of distribution within local area (population less than 100,000).Metro - 90% of distribution within larger metro area (population 100,000 or greater).Regional - 90% of distribution within 2 to 6 states.National - 90% of distribution within the nation.International - Greater than 10% of distribution outside the nation.What medium will be used for distribution?* Cable/Satellite/Wireless DVD/Videotape Internet Radio Television Theatrical Release Theatrical Stage Other Will there be bonus material?*YesNoWill bonus material use same clearance precedures as the rest of the production?*YesNoKEY PERSONNELName of Producer* First Last Name of Executive Producer* First Last Name of Script Writer* First Last ATTORNEY INFORMATIONFirm Name*Attorney Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Have you and/or your attorney read and agreed to exercise due diligence to insure that the ‘Clearance Procedures’ attached are followed?*YesNo Additional InsuredsIf you have the name, address and any special wording that is required for a distributor, financier or other party that needs to be added to the policy, you can list them here.I have an additional insured that needs to be added to this policy.*YesNo or not right now (can be added later)Most of the time the distributor or network that the production is appearing on requires that they be listed as additional insured. If you have a sample contract we can adjust the policy conditions to match those requirements.Name of Additional Insured*Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Please provide any special wording required by this entity.Coverage OptionsPlease note that the list of coverage options below are not available for all policy types. We will do our best to provide all requested coverage combinations.Media Liability Limit*Choose One$1,000,000/$1,000,000$1,000,000/$2,000,000$1,000,000/$3,000,000$1,000,000/$5,000,000$2,000,000/$2,000,000$2,000,000/$4,000,000$2,000,000/$5,000,000$3,000,000/$3,000,000$3,000,000/$5,000,000$4,000,000/$4,000,000$5,000,000/$5,000,000How many years does this policy need to be?*1 Year2 Years3 YearsRetention*Choose One$10,000 (only available if NOT theatrical release)$25,000$50,000$75,000$100,000Coverage Basis*Claims MadeOccurrence with Rights Period EndorsementOccurrence without Rights Period EndorsementClaims made policies only cover claims that are made while the policy is active. This is the standard policy type and is less expensive to obtain.Title Coverage*IncludeExcludeIf you request title coverage we will need a title search report to include it. If the title search report has a lot of hits on it, the underwriters might require a legal opinion letter from a qualified entertainment attorney as well.Additional Insured Endorsement*IncludeExcludeAdditionally Insured protects the named entity from lawsuits arising from content that is in your production. Distributors require this, as well as some managing agents, sales managers etc. What effective date do you want this policy to go into force?* Date Format: MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
