Commercial Lines – Vendor/Exhibitor ApplicationAdmin2019-01-02T11:54:11-08:00 Get started by filling out this form and someone from our team will contact you shortly! Commercial - Vendor/Exhibitor 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 for your vendors, permit offices or any other contracts that you have.Please advise the name(s) of the Owner(s)/Operator(s)/Managing Member(s) of the company:*Address (NO P.O. Boxes & NO non-U.S. Addresses)* 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 Have you had vendor/exhibitor coverage before?*NoYesAny prior claims?*YesNoPlease provide the dates, amounts of the claim(s) and descriptions of what happened:* QUALIFICATION QUESTIONSDoes the Vendor/Exhibitor's activities include any Stunts, Pyrotechnics, Hazardous Activities, Mechanical Devices, Rides, Rap/Hip-Hop/Rock/Metal Music Performances, Massage Machines?*YesNoVendor/Exhibitor will be stationed behind their booth or in a designated area throughout the event?*YesNoDoes the Vendor/Exhibitor provide bounce houses or inflatables?*YesNoConfirm your understanding that only one exhibitor at one event will be covered by the policy.*YesNoThe event will take place in the United States?*YesNo, it will take place in CanadaNoIs vendor responsible for any type of security or maintenance personnel?*YesNoWill there be any temporary structures installed/built for your event?*NoYesPlease explain.*Do you plan to hire any contractors/sub-contractors in conjunction with this event?*NoYesPlease confirm that you will obtain certificates of insurance from each contractor/sub-contractor listing you as Additional Insured on their insurance policy.*ConfirmedThis is a requirement to bind coverage.EVENT INFORMATIONPlease choose the option that best describes your vendor/exhibitor activities:*Vendor Sales: Food & Beverage (with alcohol)Vendor Sales: Food & Beverage (no alcohol)Vendor Sales: Clothing, CD/DVD, Electronics, etc.Exhibitor: Brochures and Product Information (no sales)OtherPlease explain your "other" designation.*What is the name of the event that you will be vending/exhibiting at?*What type of event will this be?*Consumer ShowFesitvalTrade ShowCarnivalOtherPlease explain your "other" designation.*Please provide a brief description of what will be going on at the event:*Outside of your own vending/exhibiting activities.Is the event open to the public?*YesNoWhat is the budget for your operations at this event?*How much will it cost you to be able to sell/exhibit at the event?How many square feet will your booth/cart/tent be occupying at the event?*How many people do you anticipate will be visiting your booth/cart/tent?*What is the name of the venue that will be hosting the event?*What is the event venue's address?* 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 What is the name of the person or entity that is organizing the event?What is the Event Organizer's address? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country COVERAGE OPTIONSWhat date do you want this policy to start?* Date Format: MM slash DD slash YYYY What date do you want this policy to expire?* Date Format: MM slash DD slash YYYY If you have any insurance requirements, please upload them so that we can provide you with an accurate quote.Accepted file types: jpg, gif, png, pdf, xls, xlsx, doc, docx, tiff.LIABILITYGeneral Liability*$1 million per occurrence/$1 million aggregate$1 million per occurrence/$2 million aggregate$2 million per occurrence/$2 million aggregateDo you need primary wording?*YesNoPrimary wording would be requested by the location or promoter putting on the event under the insurance section of the contract. It is not very common and it can incur an additional premium to include it.Do you need a waiver of subrogation?*YesNoA waiver of subrogation would be also be requested by the location or promoter putting on the event under the insurance section of the contract. It is not very common and it costs additional to include.Excess Liability*Excluded$1 million$2 million$3 million$4 million$5 million$6 million$7 million$8 million$9 million$10 millionExcess Liability is additional liability that a venue might require you to have. It is not common to need this. Please check with the venue to see if it is necessary.VEHICLESAuto Liability*Exclude$1 millionWill you be renting or borrowing any vehicles in conjunction with this event?*YesNoNo, but my contract with the venue states that I have to have auto liability."Borrowing" vehicles can mean actually being lent vehicles without a fee so you can execute your operations; but it can also mean asking people who work for you to use their own personal vehicles to execute tasks for you.How much will it cost you to rent production vehicles for the event?*How much will it cost you to rent other types of vehicles for the event?*How many days will you be renting/borrowing vehicles?*How many vehicles will you be renting/borrowing?*Will any buses or vans be hired for the primary purpose of transporting people?*NoYesWill you need the policy to cover damage that may occur to the vehicles you rent/borrow?*NoYesINLAND MARINERented Equipment, Props, Sets & Wardrobe*Excluded$10,000 or less$25,000$50,000$75,000$100,000$125,000$150,000$200,000$250,000$300,000$350,000$400,000$450,000$500,000$600,000$700,000$800,000$900,000$1,000,000What is the replacement value of the equipment you plan to rent for this event?Third Party Property Damage*Excluded$250,000$500,000$1,000,000Provides coverage for permanent structures of locations (i.e.: windows, walls, floors, railings, sidewalks, etc.)INJURY TO CAST & CREWWorkers' Compensation*Excluded$1 millionWhat type of workers will you need to cover?*CrewPerformers (dance)Performers (other than dance)How much will you be paying your workers?*Please advise one of the following:*Name and Social Security Number of OwnerCompany FEINOwner/Officer First and Last Name*Social Security Number*Tax ID Number*NameThis field is for validation purposes and should be left unchanged.
