Event Form
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Name of Applicant and Mailing Address:
Property Address if different from mailing address:
Contact Number: E-Mail:
Entity Type: Individual Partnership Corporation LLC Other
Federal ID/Social Security #: Driver License #:
                                                     Underwriting Questions
1. Does the event include any of the following? (Stunts, Pyrotechnics, Aircraft, Hazardous Activities, Car Races, Precision Driving, Mechanical Devices, Film Production, Animals, Water Activities, Rides, Rap/Hip-hop/Rock/Metal music) Yes No
2. The event will take place in the United States? Yes No
3. Confirm only one event can be covered per policy. Yes No
4. Any armed private security guards? Yes No
5. Is the event for and/or include a nationally known/recognized person? Yes No
                                                      Claim History
6. Any prior event with any losses of any kind declared by the insured? Yes No
                                                      Event Information
Event Name:
Cost/Budget:
Brief Description:
Venue Name & Address:
Attendance (average daily spectators):
Liquor Liability Required? Yes No
Automobile Coverage Required (Hired & Non-owned Liability)? Yes No
                                                           Property Coverage's
Third Party Property Damage? Yes No
Rented Equipment Coverage? Yes No If so, How Much?

                                                             Coverage Days

From: 12:01am To: 12:01am

Referred by:

Comments:

IMPORTANT NOTE: This form is provided as a convenience to you. We will make a good faith effort to obtain competitive quotes for your review. Depending on the type of business, we may require more information and will contact you if necessary. Your submission of this form DOES NOT guarantee that any binding offers will be forthcoming from insurers we represent.