Short Run/Special Event Insurance Application

Application Information:

Business/Organization Name

Address

Street Address City State ZIP Code

Business Phone

Web Address

Contact Name*

Contact Phone*

Contact Email*

Years in Business

New Venture

Yes
No

Type of Business

Individual
Corporation
Partnership
Other (Explain Below)

Other Business

Venue

Venue Address

Street Address Address Line 2 City State ZIP Code

Term Needed:

Start Date

End Date

Detailed Description of Event

Typical General Liability Insurance Limits Needed for Events:

Per Occurrence - $1,000,000

Personal Injury/Advertising - $1,000,000

Prod/Comps Ops Aggregate - $2,000,000

General Aggregate - $2,000,000

Damage to Premises - $100,000

Medical Expenses - $5,000

Other Coverages Requested

Underwriting Information

# of Days of Event

Estimated Attendance per Day

Total all days

# of Performances

# of Participants

Gross Receipts

Describe seating arrangements (type, capacity, etc.):

Describe all set-up exposures (electrical, special effects, etc.):

List Additional Insureds/Certificate Holders (indicate relationship):

Food or beverage sold/served by applicant?

Yes
No

If yes, details

If concert or festival, please answer question below

Describe security arrangements

Are guards armed:

Yes
No

Do they have their own insurance?

Yes
No

Prior Insurance Information (last 3 years)

If you had insurance for similar events in the past, please complete the following

Year	Carrier	Limit	Premium

Loss Information (last 3 years)

If you had insurance for similar events in the past, please complete the following

Date of Loss	Description of Loss	Amount Incurred

Additional Information

Reference to Common Types of Insurance Needed by Performing Arts Groups/ Please Quote the Following:

General Liability: Many venues now require a Certificate of Insurance as part of the requirements to rent a space. The certificate covers against claims arising out of bodily injury to the patrons and limited property coverage to third party claims. This policy alone DOES NOT cover injury to your employees, participants, volunteers, students, or company members. It also, alone, DOES NOT cover property owned, leased, rented or borrowed by your group.
Property: This coverage will reimburse you for losses to business assets/property. There are 4 different categories to derive, each with its own dollar figure or value. The categories are: 1. Owned 2. Owned by Others (and in your organization's Care, Custody & Control) 3. Rented or Leased to your organization 4. Travels with your organization ("Inland Marine") (The typical property deductible is $1,000 per occurrence, so it may not be cost effective to insure your property if it is valued at under $10,000)
Accident Policy: Many groups have no employees, but still feel an obligation to assist participants, volunteers or students when an injury may occur. We provide an accident policy for groups that pays medical expenses on an excess basis with no deductibles. Over 90% of our accident policies written last year were for the minimum premium. The average premium was $375.

Phone

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