Entertainment – Movie BoatEmet Digital2019-01-02T12:47:08-08:00 Get started by filling out this form and someone from our team will contact you shortly! Entertainment - Movie Boat What is the name the insurance will be under?*This would be the LLC or Individual that you are using for any contracts, permits etc. What type of entity is this?* Individual LLC LLP Corporation Non-Profit Address*Please note that in order to offer a policy you have to have a U.S. address. We cannot insure a foreign entity that does not have a U.S. base of operations. Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact Person* First Last Phone*Email* Enter Email Confirm Email Any insurance declined or cancelled in the past 3 years? No Yes Any prior Movie Boat insurance policies? No Yes Please provide policy numbers, expiration date, carrier and premium of prior policies.*Will the production include any Stunts, Water-Skiing or over-the-side activities? No Yes Production Title* Type of production*i.e. commercial, feature film (theatrical), feature film (non-theatrical), educational, documentary etc. Production Start Date* MM slash DD slash YYYY Production End Date* MM slash DD slash YYYY Gross Production Cost*The total budget for the production. If filming on and off a boat only use the portion of the budget that includes the boat operations.How many episodes are there?*If this is a feature, commercial etc. just enter 1.Please enter a number from 1 to 50.Please provide at one location where filming will occurIf you don't have an exact address use the specific harbor or other type of location where the boat will be. City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Please provide a short synopsis of the production*Name of producer/executive producer/director* First Last What is their title?* Executive Producer Producer Director Driver's License Number* Driver's License StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Vessel Name* Year Built*Manufacturer/Builder* Vessel Type* Vessel Length* Vessel Registration Number* Market Value*Vessel Owner's Name* First Last Vessel Owner's Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCĂ´te d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRĂ©unionSaint BarthĂ©lemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTĂĽrkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweĂ…land Islands Vessel UseTotal days using vessel at sea*Operating use is when the vessel is not stationed at the dock.Please enter a number from 1 to 90.Number of Vessel Crew*Please enter a number from 1 to 50.Number of Film Crew, Actors & Volunteers*Please enter a number from 1 to 50.Is your company operating the vessel?* Yes No (a 3rd Party is operating the vessel) Total days using vessel at dock*Operating use is when the vessel is stationed at a dock.Please enter a number from 1 to 90.Number of Vessel Crew*Please enter a number from 1 to 50.Number of Film Crew, Actors & Volunteers*Please enter a number from 1 to 50.Describe how the vessel will be used in the production* Place of attachment* Will the vessel be used within 50 miles of attachment?* No Yes Navigation Area*The Navigation area is the territory through which the vessel travels. Coverage Start Date* MM slash DD slash YYYY Coverage End Date* MM slash DD slash YYYY Hull & Machinery Excluded Include Collision Tower's Liability Excluded Include Primary Collision Liability (Running Down Clause) Excluded Include Pollution Excluded Include Wharfinger's Liability Excluded Include Excess Liability Excluded $4,000,000 $9,000,000 Inland Marine Coverage OptionsOwned Equipment, Props, Sets, WardrobeExcluded$50,000$75,000$100,000$150,000$200,000$250,000$350,000$500,000Rented Equipment, Props, Sets, WardrobeExcluded$50,000$75,000$100,000$150,000$200,000$250,000$350,000$500,000Negative Film & Faulty Stock Excluded $25,000 NameThis field is for validation purposes and should be left unchanged.
