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  A Service of Supple-Merrill & Driscoll, Inc.




 DICE/Annual Productions 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.

  3. Glossary of Terms. 


 Program Information

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  PDF Application (Fillable)


( indicates required information)

Applicant Information

Name of Company / Organization:

Full Name of Contact:
Street Address:
City, State: ,  
Zip/Postal Code:


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

Applicant Type:


Qualification Questions

Will any production include stunts, pyrotechnics, aircraft, boats, animals, race tracks, race courses, helicopters, motorbikes, snowmobiles, ATVs, blanks, squibs, guns, or other hazardous activities?

Will any production include any Hard-Core or Soft-Core pornography?

Will any production include any live gangster rap music?

Will any production activities take place outside of the U.S. and Canada?

Any unprotected or open heights above 15 feet?

Any employees supplied to or from an employee leasing operation (i.e. PEO)?

Do You Enter into any Co-Production Arrangements?


Client Information

Type of Operations:
Description of Business / Operations:


Insurance History

Any Insurance Declined or Cancelled in the Past 3 Years?

Any prior production with any losses of any kind?

Not applicable in MO

If Yes, please describe.

Any Prior Insurance Coverage?


Risk Classification

Annual Gross Production Cost:
Maximum Budget Per Production:
Maximum Days Per Production:

Rental Operations:

Rental Operations can be included if incidental and do not exceed 50,000 in revenues.

General Information

Number of Employees:

Production Breakdown


Please Breakdown Number of Productions for Upcoming 12 Months by Type:


Animation Instructional Video Sales Video
Commercial Live Action Shot Short Film
Community TV Interview Miscellaneous Production Soap Opera
Corporate Video Motion Picture Spec Commercial
Demo Reel Shoot Music Video Spec Production
Digital Video Non Airing Pilot Television Pilot
Direct Sales Videos Photography Shoot Television Series
Directors Reel Pick-Up Shoot Television Special
Documentary Point of Sale Video "The Making of" Videos
Editing Post-production Thesis Film
Educational & Training Pre-production Trailer


Promotional Video

Training Video

Feature Film

Public Access Program

Video Biography

Festival Reel

Public Service Announcement

Video Game Shoot

Film Promotion

Reality Based TV Show

Video Location Survey

Independent Feature, Low Budget

SAG Experimental

Video Shoot (Miscellaneous)


SAG Limited Exhibition



SAG Modified Low Budget




Coverage Term

Effective Date:

Annual Policy Period


Inland Marine

Property & Equipment Coverages

Miscellaneous Rented Equipment:
Owned Equipment:
Rented Props, Sets, Wardrobe:

Rented Furs, Jewelry, Art & Antiques Coverage:

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

Negative Film, Videotape, & Digitalized Image:
Faulty Stock:

Library Stock Coverage:

Expands the definition of negative film, videotape and digitalized image to include insured's original cut negative film of completed or released productions, duplicate negatives, completed video tapes or other related media.

Extra Expense:
Third Party Property Damage:
Office Contents:
Animal Extra Expense:

Rental Cost Reimbursement:

Limit Per Day

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


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:

Attaches to EDP and provides limited coverage for computer viruses.

Accounts Receivable:
Valuable Papers and Records:
Money & Securities:
Civil Authority:

Extra expense due to the interruption, postponement or cancellation of an “insured production” that is directly caused by or results from the operation of civil authority. The operation of civil authority must prohibit access due to threat of or actual loss or damage to property allowing access to or use of facilities you occupy or intend to occupy in connection with an “insured production” during the term of coverage.

Agency and Talent Re-Shoot Costs:

Provides coverage for contractually obligated (yet unanticipated) talent, services or facilities costs incurred to reshoot the production after a covered loss.

Strikes or Civil Protest:

As a result of an officially sanctioned strike or civil protest, covers the loss due to the interruption, postponement or cancellation of the production.

Waiver of Subrogation:

Coverage Extension Endorsement:

Valuable Papers


Signs 10,000
Outdoor Property 5,000 Per Item
25,000 Total
Electronic Media And Records 5,000
Debris Removal 50,000
Employee Dishonesty 5,000
Fire Department Service Charges 25,000
Fire Equipment Recharge 10,000
Pollutant Clean Up And Removal 15,000
Sewer Backup 25,000
Temporary Location 25,000
Accounts Receivable 25,000
Money & Securities 5,000

Entertainment Enhancement Endorsement:


Single Limit by Coverage

Blanket Limit (100K)

Agency/Talent Re-Shoot Costs

25,000 / 1,500


Power Supply Interruption

50,000 / 2,500


Civil Authority

50,000 / 2,500


Strikes or Civil Protest

25,000 / 1,500


Library Stock Coverage

25,000 / 1,500


Animal Physical Damage 25,000 / 1,500 Included
Animal Extra Expense 25,000 / 1,500 Included
Equipment Breakdown 25,000 / 1,500 Included
Blanket Coverage n/a 100,000 / 2,500

The figures above represent the Limit / Deductible.

Worldwide Coverage:


Cast Extra Expense
Cast Extra Expense:

Provides extra expense incurred in the completion of a production over and above the normal budgeted costs due to the death or disability (accident or sickness) or kidnapping of any scheduled artist. Cast coverage provides protection from pre-production through production and post-production. All artists must be scheduled in advance and medicals are required for sickness coverage. For coverage on an unscheduled basis, you may also include the 'covered person extension with sickness coverage'.

Covered Person Extension (without sickness):

Provides accidental injury or accidental death cast coverage without having to schedule artists. If sickness coverage is required for any artists, those artists must be scheduled (a reduced limit for sickness coverage on an unscheduled basis is available under the 'Covered Person Extension with Sickness' coverage). Expands the definition of covered person to include any person necessary for the completion of the insured production.

Covered Person Extension (with sickness):

Provides accidental injury, death and sickness coverage without having to schedule artists. Expands the definition of covered person to include any person necessary for the completion of the insured production.

Family Bereavement:

Expands cast coverage to provide for a bereavement period up to 5 days due to the death of an immediate family member.


Equipment Floater

Unscheduled Owned Equipment:


General Liability
Occurrence / Aggregate Limit:
Fire Legal:

Medical Payments:
Blanket Additional Insured / Certificates of Insurance: Included

City/Other Special Certificates:

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

Waiver of Subrogation:

Primary & Non-Contributory Wording Occasionally Required by Locations

Employee Benefits Liability:


Automobile - Hired & Non-Owned
Physical Damage Limits:

Per Vehicle / Aggregate

Liability Limits:
Waiver of Subrogation:

Primary & Non-Contributory Wording

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.

Number of Loaned or Donated Vehicles / Days:

# of Days

# of Vehicles

Cost of Hire:

Mobile Studios and Film Trucks

Other Than Mobile Studios and Film Trucks

Will any bus or van be hired primarily for the purpose of transporting people?: Yes  No
  If yes, due to the inherent auto liability exposure of transporting people, information is required for drivers or any bus or van.
Full Name State Drivers License #


Excess Liability

Occurrence / Aggregate Limit:

The excess liability is an additional layer of coverage above the general liability, auto, and employers liability. Note that this excess policy will only sit on top of risks insured through Abacus programs.


Travel Accident

Guild Members, Non-Guild Members, Aggregate Limit:

Guild refers to employees who are part of a Guild, Trade Association or Labor Union.  The required Guild limit is $1,000,000. Non-Guild refers to all other employees.


Workers' Compensation

Available in: AL, AR, AZ, CA, CO, CT, DC, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MO, MN, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OK, PA, TN, SC, TX, UT, VA, VT, WV.

In addition, for clients located in the above states, locations can now be added for operations that occur in the following 8 states: AK, DE, HI, MA, OR, RI, SD, WI.


Waiver of Subrogation:

Primary & Non-Contributory Wording

All States Endorsement (other than monopolistic states):

Payroll Company (if any):

Identification Number:

An identification number  is required when binding Workers' Compensation coverage.

Payroll by Class Codes (if any)

# Full Time Employees

Over 25 hours/week

# Part Time Employees

Under 25 hours/week


Total W-2, 1099, & Deferred

4361 - Photography
7607 - Video Post Production
8742 - Salespersons - Outside
8810 - Clerical Office Employees - NOC
8859 - Computer Programming or Software Development
9516 - TV, Video, Audio Equipment Installation
9610 - Motion Picture Production


Full Name


Schedule an Officer:

Workers compensation coverage is not provided for officers & owners. The title for at least one officer/owner must be entered in order to proceed. To capture the required information, edit and select the title for any existing contact, and/or enter a new officer/owner.


Please provide complete street address for a location in 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.







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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