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

 

  

 

 Contractors Equipment Floater 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:

 

Underwriting Questions
Any Crane equipment or logging equipment?

Any equipment principally used underground?

Is Applicant primarily in the businesses of renting equipment to others?

 

Risk Details
Applicant's years of industry experience:

Operations:

Description of Business/Operations:

 

Insurance History
Any insurance declined or cancelled in the past 3 years?
Any losses in the past 3 years?

Any prior insurance coverage?

 

Coverage Term

Annual policy period:

Effective

 

Inland Marine
Scheduled Equipment:

Owned Equipment that is inventoried and kept on file with insurer.

Unscheduled Owned Equipment:
Rented Equipment:
Office Contents:
Extra Expense:
Equipment Leased / Loaned to Others:
Rental Reimbursement:
Business Income:
Waterborne:

Coverage for property on or within any vessel supported, carried or otherwise moved by water.

Terrorism: Included

 

Notes

 

 

 

 

Terms and Conditions

Please carefully review the Terms and Conditions below:

  • 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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ProductionInsurance.com is the entertainment division of Supple-Merrill & Driscoll, Inc.  California License 0517777.

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ProductionInsurance.com | Contractors Equipment Floater Application