Step One:
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Complete Form
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Step Two:
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Review and Submit
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Step Three:
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Finish
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Welcome to
Equipment Floater Application from Entertainment Pro Insurance.
For fast service on your commercial
accounts complete the form below and hit the “Step Two†button. Your submission
will be electronically delivered to the next available Commercial Lines Underwriter.
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CONTACT INFORMATION
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QUALIFICATIONS QUESTIONS
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Is the applicant in the business of renting equipment to others?:
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Qualification Question 1 - Yes or No Required!
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INSURANCE HISTORY
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LOSSES
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Any losses in the past 3 years? (If yes, provide details) :
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Losses - Yes or No Required!
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PRIOR COVERAGE
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Any prior insurance? (If yes, provide details) :
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Prior insurance - Yes or No Required!
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CANCELLED or DECLINED INSURANCE
(not applicable in MO)
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Any insurance declined or cancelled in the past 3 years?
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Cancelled or Declined - Yes or No Required!
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If yes, provide details:
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SECURITY
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COVERAGES
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Dates of Coverage/ Effective:
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(12 month coverage term)
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Dates of Coverage - Required!
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Coverage
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Limit
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Deductible
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Inland Marine (* Indicates required coverages if Inland Marine is purchased)
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Owned Equipment
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*
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Editing/Post Production Equipment
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Recording/Studio Equipment
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Sound/Location Recording Equipment
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Musical Instruments/Band Equipment
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Camera/Production Equipment
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P.A./Sound Equipment
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Theatrical Equipment
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Props, Sets, Wardrobe
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Rented Equipment
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Camera, lighting, sound, etc.
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Props, Sets, Wardrobe
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Furs, Jewelry, Arts, Antiques
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Negative Film, Videotape, Digitalized Image
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Faulty Stock, camera & Processing
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Same as Negative Film
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Library Stock Coverage
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Extra Expense
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Third Party Property Damage
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Office Contents
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Business Income/Extra Expense
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Rental Cost Reimbursement
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EDP
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Limited Computer Virus Coverage
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Accounts Receivable
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Valuable Papers
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Money & Securities
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Worldwide Coverage Territory
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Include
Exclude
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Waiver of Subrogation
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Include
Exclude
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Coverage Extension Endorsement*
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Include
Exclude
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500
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* (Valuable Papers 2500, Signs 10000, Outdoor Property
5000 Per Item 25000 total, Electronic Media And Records 5000, Debris Removal 50000,
Employee Dishonesty 5000, Fire Department Service Charges 25000, Fire Equipment
Recharge 10000, Polutant Clean Up And Removal 15000, Sewer Backup 25000, Temporary
Location 25000, Accounts Receivable 25000, Money & Securities 5000)
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ADDITIONAL COMMENTS:
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FRAUD STATEMENT
Any person
who knowingly and with intent to defraud any insurance company or another person
files an application for insurance containing any materially false information,
or conceals for the purpose of misleading information concerning any fact material
thereto, commits a fraudulent insurance act, which is a crime and subjects the person
to criminal and (NY: substantial) civil penalties. (Not applicable in CO, HI, NE,
OH, OK, OR, VT). In DC, LA, ME, TN and VA, insurance benefits may also be denied.
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(You will get a summary page to review
before submitting)
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