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
Short Term Film Productions EZ-Quote 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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Will the production include any Hard-Core or Soft-Core pornography?:
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Qualification Question 1 - Yes or No Required!
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Will the production include any live gangster rap music?
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Qualification Question 2 - Yes or No Required!
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Will any production activities take place outside of the U.S. and Canada?:
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Qualification Question 3 - Yes or No Required!
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Any employees supplied to or from an employee leasing operation (i.e. PEO)?
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Qualification Question 4 - Yes or No Required!
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Confirm your understanding that if coverage is provided, only one production will
be covered by the policy(s) issued:
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Qualification Question 5 - Yes or No Required!
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Any unprotected or open heights above 15 feet?:
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Qualification Question 6 - 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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PRODUCTION
DETAILS
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FOR MUSIC VIDEO ONLY
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PRODUCTION PERSONNEL
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Enter the key personnel (executive
producer, producer, director, etc.)
At a minimum, either the executive
producer or producer must be listed.
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STUNTS and/or HAZARDOUS ACTIVITIES
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Will the production include any stunts, pyrotechnics, aircraft, boats, animals,
race tracks, race courses, helicopters, motorbikes, snowmobiles, ATVs, blanks, squibs,
guns or other hazardous activities?:
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Stunts or Hazardous Activities - Yes or No Required!
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If yes, the information below is required for each stunt/hazardous activity:
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STUNTS
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Detailed Description of Stunt:
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Date(s) of Stunt:
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Stunt Coordinators/Professionals, if any:
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Licensed?:
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Permits
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Are permits required?
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Have they been obtained?
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Describe precautions taken for the
safety
of the public, participants and property:
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Any cast members involved/in close proximity:
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If vehicle(s) involved:
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# of vehicles:
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Maximum speed
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Any collisions, explosions:
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ANIMAL COVERAGE
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Type of Aminal and breed if applicable:
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Value of Animal:
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Where will animal be housed during/after filming:
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Who is responsible during transport:
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Days of filming:
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Number of scenes:
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Any replacements for the animal and
can
they substitute at all times:
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REQUIRED NOTES AND ATTACHMENTS
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Detailed synopsis of stunt:
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- Attach resume of stunt coordinator/pyrotechnician,
permits:
- Certain stunts/hazardous activities
are ineligible.
- Certain coverages (such as workers
compensation) may not be available
for productions that include stunts/hazardous
activities.
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COVERAGE OPTIONS
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General Liability
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Occurrence / Aggregate Limit:
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Select General Liability Limits - Required!
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Blanket Additional Insured/Certificate of Insurance:
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City Certificates:
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Include
Exclude
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Waiver of Subrogation
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Include
Exclude
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Inland Marine
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Rented Equipment (Camera, Lighting, Sound, etc.)
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Values over 600k require a formal resume.
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Select Inland Marine Limits - Required!
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Rented Props, Sets, Wardrobe:
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Owned Equipment, Propet Sets, Wardrobe:
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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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Third Party Property Damage:
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Extra Expense:
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Office Contents:
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Automobile
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Hired & Non-Owned Auto Liability:
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Select Hired & Non-Owned Auto Limits - Required!
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Waiver of Subrogation:
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Include
Exclude
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Hired & Non-Owned Auto Pyhsical Damage
(per vehicle/aggregate limit):
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Workers Compensation
(available in CA, NY, FL, TX, NC, TN, NV, IL, CO)
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Workers Comp required by SAG?
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Waiver of Subrogation?
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Include
Exclude
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If included, provide cert holder name/address
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Number of Shoot Days:
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Payroll Company Name (if any):
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Payroll
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Listing of All Officers (to exclude
from workers comp)
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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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