Entertainment – Special Event (Annual)Emet Digital2019-01-02T12:37:40-08:00 Get started by filling out this form and someone from our team will contact you shortly! Entertainment - Special Event (Annual) CLIENT INFORMATIONName of insured* Entity Type*CorporationLLCLLPIndividual/DBANon-ProfitApplicant's Name* First Last Address* Street Address Address Line 2 City 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 State ZIP Code Phone*Email* UNDERWRITING INFORMATIONDescribe your business operations:How many years has the business been in operation?What is the estimated number of events you have planned for the year? Do any events include any of the following: stunts pyrotechnics aircrafts car races or precision driving mechanical amusement devices film production live hip/hop, rap or metal music performances any other hazardous activities Please check all that apply.If you checked "any other hazardous activities" above, please describe.Do you have any private armed security (i.e. armed security that work exclusively for you under your employ)? Yes No Any event with bounce houses or inflatables? Yes No Please confirm you are obtaining a certificate of insurance from the entity providing them.* Confirm Are you looking for a policy that would: allow you to add events as you go or one that would cover only the events you have scheduled for the year at this time? What date would you like the coverage to start? Month Day Year What is the square footage of your office space?What is the business' annual gross revenue?How many employees do you have?What is the average number of attendees for your events? What is the maximum number of attendees for your events? Have you ever had event insurance before? Yes No If so, please provide the type of policy that was purchased (General Liability, Inland Marine, Automobile, etc.), the Carrier that provided the policy, the policy number, its expiration date and the price you paid (the premium) for the policy.If you have had event insurance before, have you incurred any losses in the past three years? If yes, please explain.LIABILITY COVERAGE OPTIONSGeneral Liability1M/1M1M/2M1M/3M2M/2M3M/3M4M/4M5M/5MChoose One.Hired & Non-Owned Auto Liability Exclude Include Include + Physical Damage HNOA covers vehicles not owned by you that cause bodily or property damage while conducting business operations on your behalf. It is excess, meaning that if a vehicle has coverage on it, that insurance pays first. The Physical Damage is the coverage for the vehicle itself, and is normally required when renting vehicles. Is coverage required for vendors/performers? Exclude Include Liquor Liability Exclude Include Host Liquor Liquor Liability covers the SALE and/or SERVING of alcohol during an event (a liquor license might be required based on the state law). Host Liquor covers the lawsuits from only the serving of alcohol not for profit, such as champagne toasts or if you provide a bottle of wine per table, etc. Will there be an open bar? Yes No What measures are in place to prevent the service of alcohol to minor and/or intoxicated persons? INLAND MARINE COVERAGE OPTIONSThird Party Property DamageExcluded$250,000$500,000$1,000,000Third Party Property Damage covers damage to the permanent fixtures of a location that you are renting for your business operations, such as windows, floors, doors, etc. Rented Equipment (Including Props/Sets/Wardrobe)Excluded$10,000$25,000$50,000$100,000$250,000otherCAST/CREW COVERAGE OPTIONSWorkers Compensation Exclude Include Workers compensation covers the cast and crew for injuries while working. It meets the state requirements for coverage if it is available in your state. You can also obtain this from a payroll service in most cases. Accident/Medical Coverage Exclude $10,000 per claim $25,000 per claim $50,000 per claim Accident/Medical provides reimbursement for medical treatment during the production. It is NOT worker's compensation and does NOT meet state requirements for Worker's Compensation insurance. This is simply a layer of protection for cast and crew for those not purchasing worker's compensation.NameThis field is for validation purposes and should be left unchanged.
