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 ProductionInsurance.com
  A Service of Supple-Merrill & Driscoll, Inc.

 

  

 

 Acquisition & Development E&O Application Instructions

  1. Please complete and submit this online application for a free, no-obligation quote.

  2. Please be sure to provide all required information in order to receive a quotation.  

 

  Program Information

This is a secure application.  Strong cryptography is implemented via the Secure Sockets Layer protocol.  Our Privacy Policy.

  PDF Application (Fillable)

 
 

( indicates required information)

Applicant Information

Name of Company / Organization:
Entity:
Full Name of Contact:
Number:
Fax:
Street Address:
City, State: ,
Zip/Postal Code:

Email:

We will never rent, sell, or share your email address.

Website:
Applicant Type:

 

General
Does the production involve any of the following: animation, pornographic materials, ride alongs, hidden cameras, pranks and consumer voting?

Yes  No

Will you be using a clearance attorney with at lease 5 years of relevant media law experience?

Yes  No

 

Operation Details

Operations:  
Description of Business/Operations:
Number of Employees:

 

Insurance History

Any insurance declined, cancelled or non-renewed that provided the same or similar coverage s the insurance sought?

Yes  No

Not Applicable in MO

Any prior E&O coverage?:

Yes  No

If Yes, please provide Policy Type, Carrier, Policy #, Expiration and Premium above.

Are You aware of any claims or legal proceedings made or commenced against You or any of Your officers, members, or partners within the last five (5) years for: (1) invasion of privacy or false light; (2) IP Infringement; (3) defamation; or (4) breach of contract arising out of the alleged submission of any ideas, story line, or script?

Yes  No

If Yes, provide Policy Type, Date of Loss, Description and Amount above.

 

Development of Projects

Do you accept unsolicited submissions outside of agents or lawyers submissions?

Yes  No

If Yes, please provide unsolicited submissions procedures above.

What percentage of projects that you acquire for development do you also produce post principle photography?

Is the production based on an underlying work?

Yes  No

If Yes,

a. Have copyright reports been obtained? Yes  No
b. Are there any ambiguities, gaps or problems in the chain of title? Yes  No
c. Has the chain of title of all works on which the production is based been thoroughly investigated and cleared back to the original copyright owners to determine that all grants or transfers in the chain of title permit you to assign or sublicense the material as incorporated in your production Yes  No

If No,

a. Are you aware of any similar format or concept? Yes  No
b. Has your attorney confirmed that they are satisfied you can safely proceed with your exploitation of the work? Yes  No
c. Has any similar format or similar material been submitted to you at any time?

Yes  No

 

Contractual Provisions for Third Party Acquired Productions

Does the applicant obtain full indemnities from sellers against liability arising out of the distribution, exhibition or other use of the productions acquired?

Yes  No

Does the applicant require the seller to warrant that each production has producers errors and omissions insurance?

Yes  No

 

Contractual Provisions for Productions Licensed for Distribution

Does the applicant obtain full indemnities from the licensor against any liability arising out of the distribution, exhibition or other use of the productions licensed for distribution?

Yes  No

Does the applicant require the licensor to warrant that each production has current producers errors and omissions?

Yes  No

 

Claims Details

Have you suffered any loss or has any claim, whether successful or not, ever been made against you?

Yes  No

If Yes, please explain below.

Are you aware of any matter which is likely to lead to you suffering a loss or claim or a claim being made against you?

Yes  No

If Yes, please explain below.

 

Material Information

Is there any other information which may be material to our consideration of your application for insurance (If you have any doubt over whether something is relevant, please let us have details).

Yes  No

If Yes, please explain below.

 

Library Details
Do you have a film library?

Yes  No

If Yes,

a. How many titles in your library?

b. What percentage of your library titles have you produced or acquired?

c. What percentage of your library titles do you license for distribution and do not own the rights?

d. What percentage of your library titles were first exhibited prior to 1978?

e. Have you purchased producer's Errors & Omissions coverage for all titles produced by you in your library?

Yes  No

f. Are any titles in the library reality, documentaries, animation or quiz/game shows?

Yes  No

 

Distribution Details
 

Estimated gross annual revenues from

Current Year

Prior Year


All Sources:

Distribution:

 

 

 

 

Third Parties

Input third parties to whom you intend to provide productions to in the coming year. (Optional)

 

Name of Third Party

Types of Productions


1. 

2. 

3. 

4. 

 

 

Estimated # of productions to be distributed annually which are:
 
Feature Film (for theatrical release)
Films for Television
Films for DVD only
Television Series
Reality Television
Webisodes/Internet Productions

Docu-dramas

Documentaries

Animation

Quiz/Game Shows

Other

 

 

Distribution Territory
 

 Local

90% of distribution within local area (population less than 100,000).
   Metro 90% of distribution within larger metro area (population 100,000 or greater).
   Regional 90% of distribution within 2 to 6 states.
   National 90% of distribution within the nation.
   International Greater than 10% of distribution outside the nation.

 

Key Personnel

Executive Producer
    First Name:
    Last Name
Producer
    First Name:
    Last Name:

 

Legal Information

Firm Name:
Attorney Name:
Street:
City:
Country:
City, State: ,
Zip:
Phone:
Fax:
Email:

 

Contractual Provisions for Third Party Acquired Productions

Does the applicant’s attorney approve as adequate the steps taken for clearance procedures in connection with the acquisition of each production?

Yes  No

View Clearance Procedures

 

Additional Insureds

The Additional Insureds is used to capture the distributors, broadcasters, investors, talent and other entities required to be named as additional insured under the policy. Certificates of insurance can be issued for the additional interests scheduled. Please note that the policy holder should not be scheduled as an additional interest.

 

 

 

Coverage Options
Effective Date / Policy Term: / 
Per Claim / Aggregate:
Retention:
Coverage Basis:

The Coverage Basis may be selected as either occurrence or claims made (depending on the program and state jurisdiction). In addition, certain programs may allow for Rights Period Endorsement (availability would be indicated inside the coverage dropdown

Additional Insured Endorsement:

Select Additional Insureds if certificates of insurance are required for distributors, studios, investors, talent and/or others.

 

Notes

 

 

 

  

Terms and Conditions

Please carefully review the Terms and Conditions below:

  • The terms specified herein are only an indication of coverage.

  • Please read all exclusions indicated on quotation.

  • The quotation received is not binding on the Insurer in any way.

  • By clicking 'Submit Application' you are not agreeing to purchase coverage.  Via email, you will receive a free, no-obligation insurance quotation.

  • 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.
  • Please note that once coverage is bound, the policy cannot be cancelled.

  • The insurance quotation will be based solely on the coverages and limits selected on this application.

  • Please ask your Supple-Merrill & Driscoll, Inc. representative to explain coverage details, exclusions, limits or other provisions of any insurance policy.

Type your name below, to indicate that you have read

and accepted the Terms and Conditions above:

 

  

 

  
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