Entertainment – Special Event ApplicationEmet Digital2019-01-02T12:37:08-08:00 Get started by filling out this form and someone from our team will contact you shortly! Entertainment - Special Event 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 to execute agreements/contracts with vendors, permit offices, locations, venues, city/state/government entities, etc.Address (No PO Boxes)* Street Address 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 Please advise the name(s) of the individual(s) who own(s) the company.* Contact Person* First Last Phone*Email* Enter Email Confirm Email What experience do you have putting on these types of events?*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:* QUALIFICATION QUESTIONSDoes the event include any of the following? Stunts, Pyrotechnics, Aircrafts, Hazardous Activities, Car Races, Precision Driving, Mechanical Amusement Devices, Film Production, Live Rap or Hip-Hop Performances?* Yes No Please describe any of the above.*Will the event will take place in the United States?* Yes No Confirm only one event can be covered by this policy.* Yes No Will there be any bounce houses or inflatables?* Yes No Does the company providing the bounce house or inflatable have insurance and list you as additional insured?* Yes No Any private armed security? (i.e. armed security that work exclusively for you under your employ)* Yes No EVENT INFORMATIONWhat is the start date of the event?* MM slash DD slash YYYY What is the end date of the event?* MM slash DD slash YYYY Do you need additional days covered for rehearsal and/or load-in, load-out?* Yes, for rehearsal. Yes, for load-in and/or load-out. Yes, for both. No Please specify the rehearsal and/or load-in and load-out dates that you need to have covered.* What is the name of the event?* What is the budget for your event?*Provide the total cost of putting on this event, DO NOT include the profit you hope to make into the budget cost.What type of event are you having?*Aerobics Show/ClassAntique ShowArcheryArt FestivalAuctionAuto ShowAward PresentationBaby ShowerBalletBanquetBaptismBar Mitzvah/Bat MitzvahBaseballBasketballBazaarBeauty PageantBicycling Event (with racing)Birthday PartyBlock PartyBoat ShowBody BuildingBowlingBridal ShowerBusiness PartyCarnival (without mechanical rides)Car ShowCar WashChamber Of Commerce EventComedy ShowConcertConsumer ShowCornfield MazeCultural Event (with music)Cultural Event (without music)Dance Competition/RecitalDrill Team ExhibitionFashion ShowFestival (with music)Festival (without music)FishingFlag FootballFootballFraternity Events (no parties)Fundraiser - AuctionFundraiser - DinnerGay PrideGolf (Amateur)Golf (Professional)GraduationHarvest Festival (no farm implements or equipment)Haunted HouseHayridesInstructional ClassesJob FairKaraokeKickboxingLectureLuncheonMartial Arts CompetitionMartial Arts DemonstrationMMAMovie ReleaseMovie ScreeningMariachiMeeting - Church MeetingMeeting - Civic ClubMeeting - ConferenceMeeting - Funeral ServiceMeeting - Professional MeetingMeeting - Union MeetingOtherParadePartyPicnic (no pools or lakes)Political RallyPromRecord ReleaseRecord SigningReunionRummage SaleRV ShowSeminarSoccerSocial GatheringStreet FairSwap MeetSwimming/Water ActivitiesTalent Show (No Rap Or Hip-Hop Performances)Talent Show (With Rap Or Hip-Hop Performances)Tap DancingTelethonTennisTheatrical Stage PerformanceTrade ShowTriathlonVoter RegistrationWalk-a-thonWedding Ceremony/ReceptionWine TastingWrestling (Amateur)Wrestling (Professional)Please pick the closest match to your event or select 'other' and provide a description below.Please explain your "other" designation.* Is there a live musical performance associated with this event?* Yes No What type of music?*2000's Pop/Soul70's Disco/Classic Rock80's Glam Rock80's Pop/Electronic/Rock90's MusicBand RehearsalBluesChoirChristianClassicalCountryCover/TributeDoo-WopFolkForeignHeavy MetalHip-Hop and/or RapJazzOtherPopR&BRockReggaeSalsaSchool Band CompetitionSpiritualSymphonyPlease explain your "other" designation.* What are the names of the artists performing?* Please include all artist names of all performers.Please provide a short description of your event.*What is the number of spectators that will be in attendance DAILY?*Spectators are people who are only at an event to view or observe the goings-on, such as ticket holders at a concert or members of the general public who attend a street fair. If you are holding a private event, (such as an office party) that will not be open to the public and is not a ticketed event, please answer 0 for this question.What is number of participants that will be attending DAILY?*Participants are people actively involved with the event, such as your crew, security, performers etc.Will there be any celebrities scheduled to attend?* Yes No Please provide a list of the celebrities.* LOCATION INFORMATIONWhat is the name of the venue?* What is the address of the venue the event is taking place at?* Street Address 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 Will this event be held indoors or outdoors?* Indoors Outdoors What experience does the location have hosting events?*Who will be responsible for providing security for this event?* Event Organizer (You) Venue How many security personnel will be monitoring the event?*Please enter a number from 0 to 1000.Will there be metal detectors that everyone (including performers) have to go through?* Yes No Will the security company have you listed as additional insured on their liability policy?* Yes No Please confirm that this event will only be taking place at one location/venue.* Confirmed No, the event will take place at more than one location. Please advise the venue names and addresses of the other location(s) that the event will take place at. If you will be at the different locations on different dates, please specify the dates you will be at each location.* Do you have any documents that specify the coverage you're supposed to have?* Yes No Providing us with requirements and/or sample COIs will help us make sure that the policy we quote meets your needs.Please upload any documents or sample COIs that have been provided.*Accepted file types: jpg, gif, pdf, png, doc, docx, xls, xlsx, Max. file size: 50 MB.LIABILITY COVERAGE OPTIONSGENERAL LIABILITY*Choose One$1,000,000/$1,000,000$1,000,000/$2,000,000$2,000,000/$2,000,000$3,000,000/$3,000,000$4,000,000/$4,000,000$5,000,000/$5,000,000Do you need Primary Wording?* Yes No This is not common, and usually incurs an additional premium. It is normally only required when a location or permit office specifically requests it.Do you need a waiver of subrogation?* Yes No This is not common and incurs an additional premium. A waiver of subrogation prevents your insurance company from seeking reimbursement from an additional insured's carrier for a claim that has been paid out on your policy.Will you need your policy to provide liability coverage for vendors and/or performers?* Exclude Include PLEASE NOTE: this would not provide coverage for injury to vendors and performers. This would cover the liability exposure for vendors, exhibitors and performers who will be participating in your event. Requesting this coverage will increase the cost of your policy, and we will eventually need detailed information about the vendors, exhibitors and/or performers that would be afforded coverage.Please provide the number of exhibitors/performers you need to include coverage for.*Performers: 0 Exhibitors: 0 Food Vendors: 0 Non-Food Vendors: 0General Liability only covers the Named Insured. If liability for vendors/exhibitors/performers is required, we will eventually need you to provide details as to how many there are and what they will be doing at the event. Providing this coverage will increase the cost of your policy.Abuse & Molestation*Excluded$50,000/$100,000$100,000/$200,000$500,000/$1,000,000$1,000,000/$1,000,000Dollar amounts refer to each claim/aggregate limits of coverage provided.Liquor Liability* Exclude Include FULL Liquor Liability Include Host Liquor Liability Liquor Liability covers the SALE and/or SERVICE of alcohol during an event. PLEASE NOTE: In order for FULL LIQUOR LIABILITY to be bound, the applicant may be required to have a LIQUOR LICENSE. Host Liquor liability provides coverage for lawsuits arising from the service of alcohol that is provided to event guests free of charge.Will the amount of liquor sales be greater than $5,000?* Yes No If so, you will need to have a liquor license in order to qualify for FULL LIQUOR LIABILITY.What are your estimated alcohol sales (gross)?*Please confirm that your business is NOT a bar, tavern, “honky tonk”, brewery, wholesale liquor distributor or retail liquor store.* Confirmed If you cannot confirm this, we cannot offer FULL LIQUOR LIABILITY. Please note that answering untruthfully will negate coverage should a claim arise.Please confirm that you have a license to sell liquor.* Confirmed If you cannot confirm this, we cannot offer FULL LIQUOR LIABILITY. Please note that answering untruthfully will negate coverage should a claim arise.Please confirm that all servers/bartenders will be 21 years of age or older.* Confirmed If you cannot confirm this, we cannot offer FULL LIQUOR LIABILITY. Please note that answering untruthfully will negate coverage should a claim arise.Please confirm that you and those selling liquor on your behalf have completed a liquor control program, which may include; either TIPS (Training for Intervention Procedures by Servers of Alcohol), TAM (Techniques of Alcohol Management) or S.E.R.V.E (Sensible Education for Responsible Vendors and Employees), or another similar program designed specifically for the purpose of providing training and education to employees who sell or serve alcohol. Confirmed If you cannot confirm this, we cannot offer FULL LIQUOR LIABILITY. Please note that answering untruthfully will negate coverage should a claim arise.Please confirm that you will not be responsible for the SALE of alcohol at the event.* Confirmed If you are responsible for the SALE of liquor/beer/wine at your event, please go back to the last question, and select "Include".Will the alcohol be served by a licensed bartender?* Yes No Describe the training and/or experience of persons serving alcohol.* Will there be an open bar?* Yes No Is BYOB (bring your own bottle) allowed?* Yes No What is the average age of attendees?*What measures are in place to prevent the service of alcohol to minor and/or intoxicated persons?* HIRED & NON-OWNED AUTO LIABILITY* Exclude Include ($1 million Limit) This provides liability coverage for vehicles that you rent or borrow. Borrowing vehicles can range from actually borrowing a vehicle specifically to execute production tasks, or asking a member of your production team to execute tasks using their personal vehicle. Will you need the policy to provide coverage for damage that may be caused to rented or borrowed vehicles? This is known as auto physical damage coverage.* No Yes What limit of auto physical damage coverage would you like the policy to have?*$125K/$500K$250K/$500K$125K/$2 million$250K/$2 millionDollar amounts refer to each claim/aggregate limits of coverage provided.How much will it cost you to rent production vehicles?*Such as mobile studios and equipment trucks.How much will it cost you to rent other types of vehicles?*Such as passenger vehicles.How many days will you be renting or borrowing vehicles?*Rented vehicles have a cost (rental fee) associated with their use. Borrowed vehicles are either loaned to the production without cost, or are commandeered via asking a member of the production to use their personal vehicle to execute production tasks.How many vehicles will you be renting or borrowing?*Rented vehicles have a cost (rental fee) associated with their use. Borrowed vehicles are either loaned to the production without cost, or are commandeered via asking a member of the production to use their personal vehicle to execute production tasks.Will you be renting any buses or vans for the primary purpose of transporting people?* Yes No UMBRELLA/EXCESS LIABILITY*Excluded$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000$6,000,000$7,000,000$8,000,000$9,000,000$10,000,000OtherIt is not common to need Umbrella/Excess liability (especially for smaller events). Requesting this line of coverage will increase the cost of coverage by at least a few hundred dollars. If you're not sure whether you need it, you probably don't.Please specify how much Umbrella/Excess Liability you will need.*INLAND MARINE COVERAGE OPTIONSRented Equipment (Including Props/Sets/Wardrobes)*ExcludeIncludeWhat is the replacement value of the equipment and props sets & wardrobe that you will be renting?*What type of equipment are you renting that needs to be covered?* Will you be responsible for transporting the equipment?* Yes No Will the equipment stay in your possession at all times prior to returning to rental company?* Yes No Will the equipment be stored overnight?* Yes No Where will the equipment be stored?* What security measures will be in place to protect the equipment from theft and/or damage overnight?* Third Party Property Damage*Excluded$250,000$500,000$1,000,000Third Party Property Damage covers damage to the permanent structures of a location you're renting, such as windows, floors, doors, ceilings, railings, etc. It would not provide coverage for other things that might be damaged at a location, like furniture, decorations, rugs, window dressings, etc. If you need coverage for things like that, please request Rented Equipment (including props, sets & wardrobe) coverage.CAST/CREW COVERAGE OPTIONSWorkers Compensation Exclude Include Worker’s 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.How many total cast/crew do you need to cover?*What is the total payroll for your cast/crew?*Please provide one of the following* Tax ID Number Name and Social Security Number of an officer/owner Tax ID Number* Name of officer/owner of the company* First Last Social Security Number* Spectators & Participants Accident Medical*Exclude$25K/$25K/$25K$25K/$25K/$50K$50K/$50K/$50KProvides coverage up to the limits offered regarding death, dismemberment or medical bills.Covered Individuals* Participants Only Spectators Only Participants & Spectators Participants are people who will be actively participating in putting on the event. Spectators are people who will be in attendance at an event (i.e. ticket holders and members of the general public). Will you be paying Participants for their work?* No Yes Number of Participants to be Covered*Number of Spectators to be Covered*NameThis field is for validation purposes and should be left unchanged.
