Entertainment – Foreign Productionadmin2018-08-20T19:26:22+00:00 Entertainment - Foreign Production 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 Any prior insurance?*YesNoAny bankruptcy in the last 5 years?*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:*Does the production include any Stunts, Pyrotechnics, or Underwater Activities?*NoYes Production InformationTitleType of production*AnimationCommercialCorporate VideoDocumentaryEducational VideoFeature (for theatrical release)Feature (not for theatrical release)Music VideoOtherReality TV (Scripted)Reality TV (Unscripted)Short FilmTelevision PilotTelevision SeriesTotal Budget*Production Start Date* Production End Date* Number of Episodes*CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweState/Province*Shooting LocationSynopsis*Please provide a plot outline for your production. Coverage DatesCoverage Start Date* Coverage End Date* General LiabilityGeneral Liability1M/2M2M/2M3M/3M4M/4M5M/5MWaiver of SubrogationExcludeIncludeAuto LiabilityHired & Non-Owned Auto LiabilityExcluded1M2M3M4M5MAuto Physical Damage (25K/25K)ExcludeIncludeEmployers ResponsibilityBenefits for Voluntary Compensation-North AmericansExcluded1M2M3M4M5MNumber of Employees from US and/or Canada*Maximum Number of Employees Per Flight*Excluded12345Inland MarineUnscheduled Owned EquipmentExcluded50k75k100k150k200k250kRented Equipment, Props, Sets & WardrobesExcluded50K75K100K150K200K250KTravel AccidentGuild Members, Non-Guild Members, Aggregate LimitGuild refers to employees that are part of a Guild, Trade Association or Labor Union. Non-Guild refers to all other employees.1M Guild / 50K Non-Guild / 5M Aggregate1M Guild / 100K Non-Guild / 5M Aggregate1M Guild / 250K Non-Guild / 5M Aggregate1M Guild / 500K Non-Guild / 5M AggregateExcludedNameThis field is for validation purposes and should be left unchanged.
