Applicant Information

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Client Information

Insurance History

Coverage Options

Annual policy period

Inland Marine

Equipment & Property Coverage

< select > 5,000 10,000 15,000 25,000 35,000 50,000 75,000 100,000

The Props, Sets & Wardrobe form provides up to $25,000 for furs, jewelry, arts, antiques coverage.  If a higher limit is required, include the additional limit under this coverage.  A schedule/appraisal for the item(s) will be required.

Hired & Non-owned Auto Physical Damage:

Excluded 125,000/500,000 w/ 10% 1,500 Deductible 125,000/500,000 w/ 10% 2,500 Deductible 250,000/500,000 w/ 10% 1,500 Deductible 250,000/500,000 w/ 10% 2,500 Deductible 125,000/2,000,000 w/ 10% 1,500 Deductible 125,000/2,000,000 w/ 10% 2,500 Deductible 250,000/2,000,000 w/ 10% 1,500 Deductible 250,000/2,000,000 w/ 10% 2,500 Deductible

Per Vehicle / Aggregate Limit

Excluded 5,000 10,000 25,000 50,000 75,000 100,000 125,000 150,000

Covers the potential additional expense to rent similar equipment after a loss.

EDP:

Excluded 25,000 w/ 500 Deductible 25,000 w/ 1,000 Deductible 25,000 w/ 1,500 Deductible 50,000 w/ 500 Deductible 50,000 w/ 1,000 Deductible 50,000 w/ 1,500 Deductible 75,000 w/ 1,500 Deductible 100,000 w/ 1,500 Deductible 150,000 w/ 1,500 Deductible 200,000 w/ 1,500 Deductible 250,000 w/ 1,500 Deductible 250,000 w/ 2,500 Deductible 300,000 w/ 1,500 Deductible 300,000 w/ 2,500 Deductible 350,000 w/ 1,500 Deductible 350,000 w/ 2,500 Deductible 400,000 w/ 2,500 Deductible 400,000 w/ 3,500 Deductible 450,000 w/ 2,500 Deductible 450,000 w/ 3,500 Deductible 500,000 w/ 2,500 Deductible 500,000 w/ 3,500 Deductible 500,000 w/ 5,000 Deductible 550,000 w/ 5,000 Deductible 600,000 w/ 2,500 Deductible 600,000 w/ 3,500 Deductible 600,000 w/ 5,000 Deductible 750,000 w/ 2,500 Deductible 750,000 w/ 3,500 Deductible 750,000 w/ 5,000 Deductible 700,000 w/ 5,000 Deductible 1,000,000 w/ 3,500 Deductible 1,000,000 w/ 5,000 Deductible 1,000,000 w/ 7,500 Deductible

Electronic Data Processing Equipment

Computers and related equipment, media, software. Software extra expense is automatically included up to 25% of the hardware limit.

Limited Computer Virus:

Excluded 10,000 25,000

Attaches to EDP and provides limited coverage for computer viruses.

Waiver of Subrogation:

Coverage Extension Endorsement:

Worldwide Coverage:

Blanket Additional Insureds/Certificates of Insurance:

City/Other Special Certificates:

Excluded Included

FilmL.A., Inc., NYC Mayor's Office of Film, Cities that require Special Wording on Certificates, etc.

Excluded Included

Primary & Non-Contributory Wording Only if Required by Locations and Vendors.

Employee Benefits Liability:

Excluded Host Liquor Only Full Liquor Coverage

Host Liquor Only provides coverage under the General Liability form if the insured is not in the business of manufacturing, selling, serving, or furnishing alcoholic beverages. Full Liquor Coverage provides coverage under a separate liquor liability form. Full Liquor Coverage is not available in the following states NC, RI, VT.

Excluded (None) 5,000 10,000 15,000 25,000 35,000 50,000 75,000 100,000

Excluded 50,000/100,000 100,000/200,000 500,000/1,000,000 1,000,000/1,000,000

Each Claim / Aggregate

Excluded 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000

Hired & Non-Owned Auto Liability is rated based upon the cost to rent vehicles, duration of rentals and the number of vehicles that will be rented.

Occurrence/Aggregate Limit:

Excluded 1 million / 1 million 2 million / 2 million 3 million / 3 million 4 million / 4 million 5 million / 5 million 6 million / 6 million 7 million / 7 million 8 million / 8 million 9 million / 9 million 10 million / 10 million

The Excess Liability is an additional layer of coverage above the General Liability, Auto and Employer's Liability.  Not that this Excess policy will only sit on top of risks insured through this program.

Spectators & Participants Medical

Available in all states except MD, MO, OH & WA

Accident Medical Benefit:

Excluded 25,000/25,000/25,000 25,000/25,000/50,000 50,000/50,000/50,000

Death / Dismemberment / Medical

Covered Individuals:

Limits:

Waiver of Subrogation:

Excluded Included

Primary & Non-Contributory Wording.

All States Endorsement (other than monopolistic states):

Payroll by Class Codes (if any)

Officers

Schedule an Officer:

Locations:

Please provide complete street address for a location each state.

Although the workers compensation policy includes an all states endorsement, certain states may deny benefits if an address in that state is not scheduled on the policy.

To minimize the chance of a claim denial, please schedule a location in each state that the production will occur.  Only one location in each state is required.

Note: All productions shooting in New York are required by the NY Workers Comp Bureau to schedule a NY Location.

Notes