Commercial Lines – Venue Supplemental ApplicationEmet Digital2019-01-02T11:56:46-08:00 Get started by filling out this form and someone from our team will contact you shortly! Commercial - Venue Supplemental Application Step 1 of 10 10% General InformationName of applicant* First Last Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 Country Physical Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 Country Name of Contact* First Last PhoneEmail* Website Business Type?* Corporation Partnership Individual Non-Profit Government Entity Does the insured own or lease the facility?* Own Lease Year business was established?*Number of years under current management?*FEIN* Federal Employer Identification NumberPlease list all Named Insureds and their Interests*Named InsuredsInterests NOTE: The First Named Insured requires common/majority ownership of each named insured. Property InformationYear built?*Building construction type?* Frame Non-Combustible Modified fire resistive Masonry Masonry Non-Combustible Fire resistive Roof construction type?* Asphalt Composite Asphalt Tile Clay Tile Wood Shingle Please list all property on the roof. (HVAC, Etc.)*What is the plan for inspection and abatement?*Has it been inspected for lead paint and abated if necessary?* Yes No Year of roof upgrade?*Please provide a date or estimate of the last roofing upgrade.Year of plumbing upgrade?*Please provide a date or estimate of the last plumbing upgrade.Year of wiring upgrade?*Please provide a date or estimate of the last wiring upgrade.Year of HVAC upgrade?*Please provide a date or estimate of the last HVAC upgrade.Any planned renovations?* Yes No Please explain.*Distance to nearest fire hydrant (in feet)?* Distance to nearest fire department (miles)?* Volunteer fire department?* Yes No Is your facility a historical landmark?* Yes No Life SafetyIs the property 100% sprinklered?* Yes No Any Omega sprinkler heads?* Yes No Date of last service:* Month Day Year Please provide a date or an estimated dateDate of last sprinkler flow test:* Month Day Year Please provide a date or an estimated dateNumber of currently tagged and operational fire extinguishers.*Central station fire alam?* Yes No Central station burglar alarm?* Yes No Survellance cameras?* Yes No Cooking facilities on premises?* Yes No Automatic extinguishing system over deep fat fryers, grills & stoves?* Yes No How often are hood/ducts cleaned/serviced?* Weekly Bi-weekly Monthly Every 6 months Yearly Who are they cleaned by?* Insured Sub-contractor Date of last service:* Month Day Year How many means of egress?*Are doors locked during performances?* Yes No Are all exits clearly marked?* Yes No Are all doors equipped with panic hardware?* Yes No Do you have Automated External Defibrillator(s) (AED)?* Yes No Are your staff members trained to use them?* Yes No Do you have backup emergency lighting and/or emergency generators in the event of a power failure?* Yes No Do you have an emergency evacuation plan?* Yes No If yes, please attach a copy.Max. file size: 50 MB.Evacuation procedures and floor plans posted?* Yes No Are parking lots well lit?* Yes No Security personel?* Yes No General LiabilityNumber of Attendees ( All Events):* Total Number of Employees:* Annual Payroll:* Annual Food/Restaurant Sales or receipts:* Annual Liquor sales/ receipts:* Annual Gift Shop sales/ receipts:* Annual Parking sales/ receipts:* Other Sales/ Receipts: Who is responsible for premise defects operations?* Owner Insured Sub-contractor Who is responsible for facility maintenance operations?* Owner Insured Sub-contractor Who is responsible for the stage / lighting operations?* Owner Insured Sub-contractor Who is responsible for food concessions operations?* Owner Insured Sub-contractor Who is responsible for liquor operations?* Owner Insured Sub-contractor Who is responsible for gift shop operations?* Owner Insured Sub-contractor Who is responsible for parking operations?* Owner Insured Sub-contractor Who is responsible for security operations?* Owner Insured Sub-contractor Who is responsible for first aid operations?* Owner Insured Sub-contractor Who is responsible for pyrotechnics / fireworks operations?* Owner Insured Sub-contractor Who is responsible for Inflatables / amusement device operations?* Owner Insured Sub-contractor The Indemnification / Hold Harmless wording is in favor of:* Insured Sub/Tenant Mutual Neither Regarding contracts and certificates of insurance with sub-contractors and tenants.The additional insured status is in favor of:* Insured Sub/Tenant Mutual Neither Regarding contracts and certificates of insurance with sub-contractors and tenants.Minimum insurance limits of $1,000,000?* Insured Sub/Tenant Mutual Neither Regarding contracts and certificates of insurance with sub-contractors and tenants.A certificate of insurance required for:* Insured Sub/Tenant Mutual Neither Regarding contracts and certificates of insurance with sub-contractors and tenants.Is there temporary seating?* Yes No Is the seating inspected before each performance?* Yes No What type of seating?* Any self-promoted or co-promoted events?* Yes No Please provide a schedule*Any performing arts camps?* Yes No Please attach a brochure.Max. file size: 50 MB.Number of days the camp is open?*What kind of camp?* Day camp Overnight camp Number of Campers?*Age ranger of campers?* Do you have any field trips?* Yes No Please provide a schedule*Are waivers with parental/guardian consent required?* Yes No Please attach a copy.*Max. file size: 50 MB.Any child care services provided?* Yes No Please provide details.* Coverage limits requested for:Each occurrence / Each claim:*General aggregate:*Products/ Completed Operations aggregate:*Personal / Advertising Injury:*Damage to Premises Rented to You:*Liquor liability:*Stop Gap:*Employee benefits liabilityLimitNumber of Employees Employed benefits administrator?* Yes No Current carrierCarrier NameLimitRetroactive date Deductible:*Retention limits*Self-InsuredSelf-Funded Other coverage limits requested? Abuse and MolestationDoes your current insurance program include Abuse and Molestation coverage?* Yes No Do your employment and volunteer applications include questions about whether the individual has ever been convicted of any crime, including sex related or child abuse related offenses?* Yes No Are formal written procedures in place for hiring?* Yes No Please attach a copy.*Max. file size: 50 MB.Do you verify employment references for employees and volunteers?* Yes No Are personal interviews conducted?* Yes No Is there a written supervision plan that monitors staff in day-to-day relationships with clients, both on and off premises?* Yes No Please attach a copy.*Max. file size: 50 MB.Do you have a written crisis plan for dealing with employees, volunteers, victims, parents, authorities and the media if you have an incident of abuse?* Yes No Please attach a copy.*Max. file size: 50 MB.Have any incidents resulted in an allegation of sexual abuse?* Yes No Was the case settled?* Yes No Was the case taken to trial?* Yes No Amount paid for damages to the victim.* Does your state allow criminal background checks?* Yes No Do you run criminal background checks prior to hire for:*EmployeesVolunteersBothNoneIs security the responsibility of the Insured?* Yes No Is liquor sold at venue?* Yes No Are pyrotechnics used?* Yes No SecurityWho is primarily responsible (via contact) for liability coverage for security personel?*InsuredMunicipalitySub-contractorSecurity is*EmployedSub-contractedEmployed is defined as individuals being paid and supervised directly by the insured. "Contracted" is defined as the existence of a written contract with another entity for security services that his separate insurance coverage and provided a certificate naming the Insured as Additional Insured with limits equal to or greater than the Insured.Number of unarmed security personnel:* Payroll of unarmed security personnel:* Are there any armed security personnel?* Yes No Number of armed security personnel (not including off duty police officers):* Payroll of armed security personnel:* Are there any off duty police officers?* Yes No Number of off duty police officers:* Payroll of off duty officers:* Cost of sub-contracted security personnel:* Maximum hours per day permitted at this and all other places of employment:*Please enter a number from 0 to 24.Maximum hours per week?*Please enter a number from 0 to 100.What are the staffing guidelines per number of patrons?* What are the guidelines determined by?* Ordinance Statute Industry standard Is there a procedure to immediately report all incidents to the facility manager?* Yes No Please provide details.*Does the supervisor make personal contact with each security person at least once during each shift?* Yes No Please provide details.*Does the application require atleast three (3) personal references?* Yes No Does the hiring procedure include calling previous employers and personal refrences?* Yes No Is completion of a minimum twenty (20) hours initial training program required before deployment?* Yes No Is a minimum of ten (10) hours on-site training required?* Yes No Is a minimum of four (4) hours of annual refresher or continuing education training planned and conducted for each security employee?* Yes No Who conducts the training and what are the trainers qualifications?*Is each security person given a personal copy of the training/safety manual?* Yes No Please attach a copy*Max. file size: 50 MB.Has each security person given management a written acknowledgement or the policies and contents?* Yes No Please attach a copy*Max. file size: 50 MB.Armed Security EmployeesAre the security personnel in uniform?* Yes No Please discribe the uniform:*Are the security personnel identified by anything other than a uniform?* Yes No Please provide an example or photograph:Max. file size: 50 MB.Are psychological screen profiles used?* Yes No What type?* Are criminal background checks completed?* Yes No What agency is utilized?* Please indicate any equipment carried or routinely available to security personnel Flashlight Handcuffs Nightstick Taser/Phaser Firearms First Aid Kit (including blood borne pathogen kit) Chemicals (Mace, Pepper gas) Flashlight: type, size, and construction* Is the nightstick police regulation?* Yes Firearm caliber?* .357 .38 .9mm Firearm make?* Colt S&W Ruger Is the ammunition* Standard Firearm Holster type?* Is the firearm ammunition approved and inspected by management or security company?* Yes No Are dogs used in your security operations?* Yes No Breed / Number of dogs* Discribed duties of the dog.* LiquorIs the liquor license in Applicant's name?* Yes No What is the name on the license and their relationship to the insured?*Liquor license number:* Class of license:* Is the liquor service subcontracted to a third party?* Yes No Please provide limits of liability maintained by the sub contractor.* Is Applicant listed as Additional Insured under sub-contractors liquor liability coverage?* Yes No Is Contingent Liquor liability coverage requested by Insured?* Yes No Has Applicant's liquor license ever been revoked or suspended?* Yes No Please explain:*Has applicant incurred claims for Liquor liability during the last three (3) years?* Yes No Please explain:*Has any insurer cancelled or non-renewed coverage during the last three (3) years?* Yes No Please explain:*Has applicant ever been fined by Alcoholic Beverage Control or other governmental regulators?* Yes No Please explain:*Type of beverages sold?* Liquor annual gross sales*Food annual gross sales*Other annual gross salesAre patrons allowed to carry alcoholic beverages onto the premises?* Yes No What type of beverages?* Do you exercise the right to search and seizure contraband items?* Yes No How do you notify the public of this?* Do you maintain security personnel at entry check points?* Yes No What type of security?* Are alcohol sales and consumption contained within one fixed site, or are booths/stands located throughout the event site?* Number of servers?Are they professional servers?* Yes No Are they volunteer servers?* Yes No Do the servers receive any type of alcohol awareness training?* Yes No Please discribe:*Median age of liquor customers:*21-2525-3030-4040 and overAre minors allowed to enter the location where alcohol is being served?* Yes No Please Explain how ID's are checked:*What type of officers are present at the site of alcohol sales?* Uniformed police officers Undercover police officers Private security officers None Average number of officers present at site:*Are rules and regulations clearly displayed for patrons viewing?* Yes No Please discribe:*Is there a limit placed on the quantity of alcoholic beverages purchased at one time?* Yes No Please explain:*Is the parking area patrolled to prevent intoxicated drivers from leaving the premises?* Yes No Is there any type of designated driver program?* Yes No Limit of liquor liability coverage requested?* PyrotechnicsLimit of liability requested?*Please provide a discription of events:*Please list the location events and dates*LocationDate Who is the authority having jurisdiction over the use of pyrotechnics at your facility?* Local fire department State fire marshal What permit process must be followed prior to use of pyrotechnics at your facility?*Have you staged pyrotechnic displays before?* Yes No Please list any claims/losses that have occurred and the amount of lossDiscriptionDate of OccurrenceAmount of Loss Who will be the pyrotechnics operator?* Name Insured Contractor List names of people shooting and describe their experience*NameExperience NOTE: This coverage will exclude bodily injury liability to the fireworks shooter.Where are the pyrotechnics stored when not in use?*Does it meet federal/state storage regulations?* Yes No Describe the type of show and amount of pyrotechnics used in recurring events*Describe what fire prevention and suppression measures are taken to support the pyrotechnic loading and firing process*Does the applicant secure proper pyrotechnic permits for each event?* Yes No Are the shooters listed above licensed for pyrotechnics?* Yes No Name of Operator* First Last Is there and agreement with the contractor?* Yes No Please attach a copy of the agreement*Max. file size: 50 MB.Will liability coverage be provided by the pyrotechnics contractor?* Yes No Please indicate limits of coverage provided:* $1,000,000 Greater than $1,000,000 Please attach a copy of certificate of insurance including any additional insured listing*Max. file size: 50 MB.Do you confirm that the contractor has secured the proper pyrotechnic permits for each event?* Yes No Describe what fire prevention and suppression measures are taken to support the pyrotechnic loading and firing process*Do you allow tenant users (including temporary tenant users) to conduct pyrotechnic displays either themselves or through a contractor?* Yes No Does the tenant lease/ use agreement indicate that pyrotechnic displays are not permitted* Yes No What steps are taken to ensure that the appropriate permits are granted, appropriate fire safety codes are met, and that insurance has been obtained from either the tenant or the tenant's contractor which lists the Applicant as an additional insured?*Are events with pyrotechnics held :* Indoors Outdoors Both What type of pyrotechnics will be displayed (as defined in NFPA code 1126)?* Aerial Shells Concussion Effects Flash Pots Mines Wheels Airbursts Concussion mortars Flashpower Mortars Salutes Black Powder Saxon Gerbs Rockets Comets Flares Integrals Mortars Electric matches Waterfall, Falls, Park Curtains Are the events in compliance with NFPA 1123 or 1126 (Code for fireworks display)* Yes No Is there fencing to keep spectators away from restricted areas during the fireworks shooting?* Yes No Distance of spectator fencing from launch site?* Distance of spectator parking from launch site?* Distance of closest building or structure from launch site?* Will there be firefighting equipment on site during the event?* Yes No Distance to nearest fire station?* Will you have an ambulance on site?* Yes No What is the estimated response time of an ambulance?* Distance to nearest Medical center?* Are the events in comliance with NFPA 1126 (Standard code for the use of pyrotechnics before a proximate audience* Yes No Is the facility sprinklered?* Yes No What other form(s) of firefighting equipment is available at the facility?*Does the Facility have an emergency evacuation plan?* Yes No How often is the staff drilled on emergency evacuation?* Every event Weekly Bi-weekly Monthly Every 6 months Yearly Number or accessible (not locked) emergency exits at the facility:* Maximum capacity of the facility:*What steps are taken to inform patrons of the locations of all emergency exits?*Has the fire marshal approved the use of pyrotechnics at the facility?* Yes No As of what date?* Month Day Year Hired & Non-owned AutoDoes the Applicant have any owned automobiles?* Yes No NOTE: If Applicant has owned autos the hired car and non-owned auto coverage should be placed with the automobile carrier.Does the applicant allow employees to use their own personal vehicles for business purposes?* Yes No How often?* Daily Weekly Monthly How many employees use their own personal vehicles?*Do you confirm that all employees who regularly use their cars for business purposes carry minimum personal auto limits?* Yes No What minimum limits are required?*Do you obtain Motor Vehicle Reports?* Yes No How often?* Annually Every other year? Please provide the approximate cost of hire for all hired or leased autos during the course of the policy period:*Limits of coverage required?* $100,000 $300,000 $500,000 $1,000,000 Is hired auto physical damage required?* Yes No What is the maximum value of hired vehicle you would like insured*NOTE: Physical Damage deductibles provided $100 comprehensive/ $1,000 collision.NameThis field is for validation purposes and should be left unchanged.