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ENTERTAINMENT PRO INSURANCE
   Motion Picture, Television, Theatrical, Music, Broadcasting and Special Events   
   
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Step One: Complete Form
Step Two: Review and Submit
Step Three: Finish
Welcome to Special Events 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.
[ Required fields are bordered in red ]
 
  CONTACT INFORMATION
Name of Your Company / Organization:
  
Entity Type ( Indiv, Corp. LLC, etc.):
Physical Street Address (No P.O. Box):
City:
State, Zip Code:
Mailing Address (P.O. Box - okay):
Contact Person:
Phone:
Fax:
E-mail Address:
Website Address:
How much experience do you have at operating this type of event?
    QUALIFICATIONS QUESTIONS
Any: Stunts, Pyrotechnics, Aircraft, Hazardous Activities, Car Races,
Precision Driving, Mechanical Devices, Film Production, Rap/Hip-Hop, Rock/Metal,
Rides, Water Activities:
The event will take place in the United States:
Any armed private security guards?
Any Prior event with any losses of any kind?
Any bounce houses or inflatables (If yes, certificates of insurance are required)
Will your event occur in a bar or nightclub?
(Concert): Is there assigned seating?
Will there be temporary structures installed/built for your event?:
    EVENT DETAILS    
     
  COVERAGE DATES OF THE EVENT  
  EFFECTIVE:  
  EXPIRATION:  
  Time of Event:  (If event is past midnight - add extra day - as insurance expires at 12:01am)  
  Load In / Load Out Dates:
Do you want these rates included in your quote?
 
   
  ATTENDANCE  
Important for rating purposes -->
Average Daily Spectators/Guests:
 

Important for rating purposes -->
Average Daily Participants: (volunteers, ushers, ticket takers, athletes, performers, etc.)
Please describe participants and how many of each: 
 
   
Type of Event:
Is there overnight stays/camping:
Event Name:
Budget (Cost of Event):
Brief Description of Event:
Event Website:
Venue Name:  
    Physical Street Address (No P.O. Box)
    City, State, Zip:
Location Information:
  PLEASE ATTACH A COPY OF THE VENUE CONTRACT OR SAMPLE VENUE CONTRACT ON STEP TWO OF THIS APPLICATION
Any Celebrities at Event? None
List Celebrities (if any) at Event:
   MUSIC/BANDS/PERFORMERS/ENTERTAINMENT
Type of Performance/Entertainment (DJ, Solo Artist, Live Music, Comedian):
Name of Performer/Entertainment:
Type of Music:
Music Decade:
Artist/Band Name:
Do you require an additional insured certificate from the entertainers naming YOU as an additional insured on their insurance policy?
     If not, there may be an additional premium charge of $135 (minimum) depending on the insurance market used to insure the band/performer with their own policy.
   ADDITIONAL INSUREDS 
Do you hire any subcontractors for the insured event(s), (ie: caterers, bands/entertainment, lighting, sound, staging, decorations, security, etc.)?
   If Yes, Please describe:
Do you require all subcontractors to have their own insurance and provide you with a Certificate of Insurance (COI) naming you as an Additional Insured (AI)?
 
How many security personnel will be present? (If none, enter: 0) 
  Please note that for higher risk events it may be required to have 1 security person per 100 attendees.

If private security company is used, we will require a Certificate of Insurance.
Do you hire security?
Name of Security Company: 
Number of Types (If none, enter: 0):  
On Duty Police Officers:
Off-Duty Police Officers:
Private Armed Security:
Uniformed (unarmed) Security:
T-shirt Security:
Other:  
Do you have metal detectors at all entrances and exits that
attendees and performers must pass through?
 
  This will be required for higher risk events.
 
   COVERAGE OPTIONS 
GENERAL LIABILITY  
  Blanket Additional Insureds & Certificates, including City Certs:     Automatically Included  
   
Occurrence / Aggregate Limit:
 
  Waiver of Subrogation (only if required by contract):    Include   Exclude
 
  If "Include" is selected:
   1. What is the name of the entity requesting the waiver of subrogation?  
   2. What is their involvement in the event?  
 
ADDITIONAL COVERAGES
  Rented Equipment Limit ($5,000 minimum - $2,000,000 maximum):   $
  Dates rented equipment will be in delivered and returned
 
  1a. Will rented portable equipment (i.e. lighting, sound, video, portable toilets, generators, forklifts, etc.) 
      Dollar replacement value required (you may have to ask the rental company for the values):  $
   
  1b. Will rented Furniture be used (i.e. dining tables, any kind of chairs, sofas, coffee tables, end tables, etc.): 
      Dollar replacement value required (you may have to ask the rental company for the values):  $
   
  1c. Will rented Fixtures be used (i.e. awnings, tents, etc.): 
      Dollar replacement value required (you may have to ask the rental company for the values):  $
   
  1d. Will rented Growing Plants be used (i.e. ficus trees /bushes, other types of potted plants be used as barriers or decoration): 
      Dollar replacement value required (you may have to ask the rental company for the values):  $
     
  2. Will the property be stored overnight? 
       If Yes, please provide details on how it will be stored:
     
  3. Will you be responsible for transporting the property?
 
 
If "Yes": Please describe how it is being transported: 
If "No": Name of who is transporting the property?
1. Who is transporting the property? 
 
You:
       Rental House
       Other:
2. Is the company transporting the property naming you as an Additional Insured on their insurance policy?
     
  4. Will the property stay in your possession at all times prior to returning to rental company? Will it be secure?
    Please explain: 
 
 
 
Third Party Property Damage (Minimum premium $100):
    (Important Coverage for the Venue)
   
 
Liquor Liability ($1,000,000 Limit)         Include   Exclude
  If included, Will alcohol be served by a Licensed bartender?
If No, Who will be serving the alcohol? (If none, enter: 0)
Describe the training and/or experience of persons
serving alcohol:
Average age of attendees: (If none, enter: 0)
What measures are in place to prevent the service
of alcohol to minors and/or intoxicated persons?
(Wrist bands, stamped wrist, tickets with I.D. check, none, etc.)
Does the Applicant have a valid Liquor License?
If No, who has the liquor license?
(Please identify by name and if a
caterer, restaurant, sponsor,
event planner, none, etc.)
Please describe what kind of alcohol will be served: Beer     Wine     Cocktails    Other:
Will there be an open bar?
Will alcohol be sold by the drink?
Is BYOB (bring your own bottle) allowed?
Estimated alcohol gross receipts? (If none, enter: 0)
 
  Hired & Non-Owned Auto Liability ($1,000,000) (Minimum premium $500)    Include   Exclude
 
Check here if you are required by contract to acquire Hired/Non-Owned Auto and you NOT being loaned, rented or leased any vehicles. If checked, please provide a copy of the contract.
   If not, please complete the questions below:
       1. Amount being charged to rent or lease the vehicle(s)?     
  2. Are all drivers at least 25 years of age? 
  3. Do all drivers have a valid United States drivers license?
  4. Do any of the hired vehicles seat more than 12 people?
   
  What will the vehicles be used for? 
Event Cancellation, Participants Medical, Spectators Medical
Event Cancellation (Minimum premium $250): Include   Exclude
Participants Medical (Minimum premium $200): Include   Exclude
Spectators Medical (Minimum premium $200): Include   Exclude
 
VENDORS COVERAGE
(Only if you want your coverage extended to the vendors)
 
Number of Exhibitors (no sales):
  Concessionaires (non-food sales):
  Concessionaires (food sales):
  Performers and Attractions:
  Do you require all Vendors/Exhibitors to have
their own liability insurance and provide you with
a certificate of insurance naming you as an additional insured?
 
   
WORKERS COMPENSATION     Include   Exclude  
     Waiver of Subrogation (only if required by contract)    Include   Exclude
  If needed, please include contract with application
 
    If "Include" is Selected:
 
    1. What is the name of the entity requesting the waiver of subrogation? 
  2. What is their involvement in the event?
  Payroll Company Name (if any):
 
Payroll Classification # Full-Time # Part-Time (W-2, 1099, Deferred, Other (Please identify)
Performers
Crew/Volunteers
Others (Describe)
 
Listing of All Officers (to exclude from workers comp):
First Name Last Name Title/Position
 
   
ADDITIONAL COMMENTS:  
   
 
FOR AGENT USE ONLY
Insurance Agency Name:
Office Street Address:
City:
State, Zip Code:
Agent Contact Person:
Agent Contact Person Email:
Agent Contact Phone Number:
Agent Fax Number:
 
 
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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