Same Day Quote & Issue
Special Event Application

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For no-obligation Special Event insurance quote, please complete the following form
Customer Information
Entity Type: *
Entity Name: *
  * = Required Field
Address: *
 
City: *
State: *    Zip: *
 
Contact Person: *     
Phone: * Cell: Fax:
Email: *
Website:

 

Event Information
Event Name: *
Event Description: *
Dates:
From midnight to 11:59 PM
From:  
 
To:  

Event Type Lookup: (Optional)  
Average Daily Attendance:
Participants/Performers
Budget:
Cost Of Admissions:
Event Will Be Held:
Number of Exhibitors
Number of Vendors
Celebrities, if Any:

Venue Information
Venue Name:
Address:
 
City:
State:    Zip:

 

Qualification Questions
Any: Stunts, Pyrotechnics, Aircrafts, Car Races, Mechanical Devices, Film Production, Bounce Houses, Animals, Rides, Water Activity or Other Hazardous Activities?
Will The Event Take Place in the United States?
Any Armed Private Security Guards Hired By You or Your Company?
Have You Had Any Liability or Property Losses in the Past 5 years?

Liquor Liability:   (Show Details...)
Will alcohol be served at the event?
Is Alcohol being sold for profit?
If YES sold by whom?
Who is Liquor License Holder?
Estimated Gross Sales
Projected Profit:
Type of Alcohol Served:

Bartenders Hired By Insured?
Are Servers Trained in T.I.P.P.S ?
Will Drinking Be Limited?
For Instance: Will Tickets Be Given Out

Music / Concert Events   (Show Details...)
Genres:





Artists Names:

Sporting Events   (Show Details...)
Sport Being Played:
Are participants required to sign a waiver?
Are participants required to proof of health insurance?
Are safeguards in place to protect spectators?
   

Additional Coverage (Optional)  (Show Details...)
Excess Coverage/Umbrella:
Event Cancellation:
     Cause of Loss:
     Based on:
     Coverage Amount:  
Property/Rented Equipment:
Non-Owned/Hired Autos: ($1,000,000 Limit)
Waiver of Subrogation:
$1000 Medical Payment:

Additional Insured  (Show Details...)
Name:
Mailing Address:
City:State:Zip:
Name:
Mailing Address:
City:State:Zip:
Name:
Mailing Address:
City:State:Zip:
Name:
Mailing Address:
City:State:Zip:
Name:
Mailing Address:
City:State:Zip:
Name:
Mailing Address:
City:State:Zip:

Comments:

AFIG Producers, Enter your name and Number:
Agency Name/Number:
Producer Name:
Producer Email: