Multimedia Production E&O
(Occurrence Basis) Application
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.
PDF Application (Fillable)
indicates required information)
< select >
We will never rent, sell, or
share your email address.
1. Does the
production involve any of the following: animation, pornographic
materials, ride-alongs, hidden cameras, pranks and consumer voting?
2. Will you be
using a clearance attorney with at lease 5 years of relevant media
< select >
Miscellaneous Production Operations
1. Any insurance
declined, cancelled or non-renewed that provided the same or similar
coverage s the insurance sought?
If Yes, please provide explain. Not applicable in MO.
Any prior E&O coverage?:
If Yes, please provide Policy Type, Carrier,
Policy #, Expiration and Premium above.
3. 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?
If Yes, provide
Policy Type, Date of
Loss, Description and Amount
Is the name or likeness of any actual living person used, portrayed
or identifiable in the Named Production?
If Yes, will necessary permissions be obtained prior to first
airing, distribution or public display of the production?
3. Is the name or likeness of any actual deceased person used,
portrayed or identifiable in the Named Production?
If Yes, will necessary permissions be obtained from personal
representatives, heirs or estates prior to first airing,
distribution, or public display of the production?
Have copyright reports been obtained?
Are there any ambiguities, gaps or problems in the chain of
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?
2. Have you obtained a written agreement from all performers or persons
appearing in your production consenting to their
3. Will film clips, TV clips or photographs be used in the
Have all licenses and consents been obtained from the copyright
owner without restriction and are you authorized to assign or
sublicense the licensed materials as incorporated in your
Do you have the authorization of any person or entity depicted
in the film clip, TV clip or photograph to use their depiction
in your production and to assign or sublicense that depiction in
4. Have the following musical rights been obtained from the composer
and/or performers of specially commissioned music and/or cleared
with the owners of pre-existing music and/or recordings:
Recording and synchronization
Right to distribute for all forms of distribution contemplated
(home video, etc.)
5. Have you or any of your agents been unable to obtain or been refused
an agreement or release after having:
Negotiated for any rights in literary, musical or other
Negotiated for release from any persons in respect of any
material incorporated in the production?
1. Is coverage desired for Merchandising for this Production?
all necessary consents and licenses been obtained in respect of
any associated merchandising?
Will appropriate trademark or other searches be made before
merchandising characters or other matter that might be subject
to trademark, unfair competition or similar claims?
If Yes, please provide details below including the date of each
claim or loss, the amount of the claim and any remedial action
If Yes, please provide details of each problem above.
Title and Type
Input a brief description of the content.
Type of Work:
< select type of work>
Entirely fictional and original
Entirely fictional but based on another's work
Entirely fictional but inspired by actual events
Portrayal of actual events with original fictionalization
True portrayal of actual events
Details of the Production
How will the production be
utilize a media attorney?
Have you and your attorney read and agreed to exercise due diligence to
insure that the ‘Clearance Procedures’ attached are followed?
View Clearance Procedures
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.
Please include complete name and address for each Additional Insured:
1,000,000 / 1,000,000
1,000,000 / 2,000,000
1,000,000 / 3,000,000
1,000,000 / 5,000,000
2,000,000 / 2,000,000
2,000,000 / 4,000,000
2,000,000 / 5,000,000
3,000,000 / 3,000,000
3,000,000 / 5,000,000
4,000,000 / 4,000,000
5,000,000 / 5,000,000
Per Claim / Aggregate
< select coverage basis below >
Occurrence with Rights Period Endorsement
Occurrence without Rights Period Endorsement
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
Title coverage may be included if a title search
report is provided and approved by the insurance company.
Include Additional Insured
Endorsement if certificates of insurance are required
for distributors, studios, investors, talent and/or others.
Please carefully review the
Terms and Conditions below:
read all exclusions indicated on quotation.
The quotation received is not
binding on the Insurer in any way.
clicking 'Submit Application' you are not
agreeing to purchase coverage. Via email, you will
receive a free, no-obligation insurance quotation.
that once coverage is bound, the policy cannot be cancelled.
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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