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Entertainment - Foreign Production

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Entertainment - Foreign Production

Customer Information
What type of entity is this insurance going to be for?*
What 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 State ZIP Code
Contact Person*
First Last
Phone*
Email*
Enter Email Confirm Email
Any prior insurance?*
- Yes
- No
Please provide the policy numbers, premiums and expiration dates of your prior insurance:*
Any prior claims?*
- Yes
- No
Please provide the dates, amounts of the claim(s) and descriptions of what happened:*
Are there any planned activities involving any of the following special hazards: Stunts, Pyrotechnics, Use of Aircraft, Interaction with Wild Animals, Operation or Control of Watercraft?*
- No
- Yes
Will there be any filming whereby you will have control over the use of public roadways?*
- Yes
- No
Any bankruptcies in the last 5 years?*
- Yes
- No

Production Information
Title
Type of production*
Please explain your "other" designation:*
Total Budget*
Production Start Date*
MM slash DD slash YYYY
Production End Date*
MM slash DD slash YYYY
Country*
State/Province*
Synopsis*
Please provide a plot outline for your production.

Coverage Dates
Coverage Start Date*
MM slash DD slash YYYY
Coverage End Date*
MM slash DD slash YYYY
General Liability
General Liability
Waiver of Subrogation
- Exclude
- Include
Auto Liability
Hired & Non-Owned Auto Liability
Auto Physical Damage (25K/25K)
- Exclude
- Include
Employers Responsibility
Benefits for Voluntary Compensation-North Americans
Number of Employees from US and/or Canada*
Maximum Number of Employees Per Flight*
Inland Marine
Unscheduled Owned Equipment
Rented Equipment, Props, Sets & Wardrobes
Travel Accident
Guild Members, Non-Guild Members, Aggregate Limit*
Guild refers to employees that are part of a Guild, Trade Association or Labor Union. Non-Guild refers to all other employees.
Number of people to be covered by the Travel Accident Policy?*
Volunteer Accident
Aggregate Limit of Liability*
This would provide coverage for accidents involving unpaid volunteers.
- Excluded
- $250,000
Phone
This field is for validation purposes and should be left unchanged.

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