|
Same Day Quote &
Issue |
|
Call
Toll Free 1-800-874-9191
Fax
480-452-0593
www.EQGroup.com |
|
For no-obligation
Short Term Film insurance quote, please complete
the following form
|
| Insured Name |
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| Address
1 |
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| Address 2 |
|
| City |
|
| State |
|
| Zip |
|
| Country |
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| Entity Type |
|
| Name &
Title of Principals |
|
| Years Experience |
|
|
Primary
Contact |
| Contact Name |
|
| E-mail
Address |
|
| Primary
Phone Number |
-
(Area + Number) |
| Fax
Number |
-
(Area + Number) |
| Cell Phone
Number |
-
(Area
+ Number) |
| Website
(If Any)
http:// |
|
|
Production
Description |
| Title
of Production |
|
| Type of
Production |
|
| Brief
Description / Synopsis of Shoot |
|
| What are the
coverage dates of the shoot? |
| Start |
|
|
|
| End |
|
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| |
| Limit
of General Liability Required |
Occurrence / Aggregate |
|
What is the cost/budget of your production? |
$
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Insured Comments & Notes |
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|
Venue Details
(Location where film
shoot takes place): |
| Venue Name |
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| Venue Address
|
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| Venue City |
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| Venue State |
|
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Coverage Options
— in addition to General
Liability do you require : |
| a.
Blanket Additional Insured Endorsement? |
Automatically Included |
| b.
Third-party property damage coverage? |
|
| c. Waiver of subrogation? |
|
| d.
Rented equipment coverage needed? |
$
<-
If needed, enter total
replacement value |
| e.
Props, Sets, Wardrobe coverage needed? |
$
<- If
needed, enter total
replacement value |
| f.
Negative Film / Faulty Stock coverage? |
|
| g.
Extra Expense Coverage? |
|
| h.
Hired & non-owned auto liability? |
|
| i.
Workers Compensation Coverage Needed? |
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|
Underwriting Questions |
|
|
1.
Underwriting Questions |
| a. Does
the production include any
Stunts, Pyrotechnics, Aircraft, Boats, Animals, Race
Tracks, Race Courses, Helicopters, Motorbikes,
Snowmobiles, Blanks, Squibs, Guns, Rap Music? |
|
| b. The
event will only take place in the United States and
Canada? |
|
| c. Any
prior productions with any losses of
any kind declared by the insured and/or known by the
broker? |
|
|
How did you hear about us? |
|
| AFIG
Producer - Please enter Name & Number |
|
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|
Insurance Definitions |