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 ProductionInsurance.com

  A Service of Supple-Merrill & Driscoll, Inc.

 

  

 

 Film School Insurance 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 Qualification Questions

Will any production include any of the following?

Stunts, Pyrotechnics, Aircraft, Boats, Animals, Race Tracks, Race Courses, Helicopters, Motorbikes, Snowmobiles, ATV's, Blanks, Squibs, Guns, Hard-Core/Soft-Core Porn, or Other Hazardous Activities

Is coverage required outside of the U.S. and Canada?

Confirm your understanding that student productions are covered only if student is currently enrolled at the film school and the project is a school sanctioned project:

 

Insurance History

Any Insurance Declined or Cancelled in the Past 3 Years?

Not applicable in MO

Any prior production with any losses of any kind?

Any Prior Insurance Coverage?

 

Film School Information

Year Film School Established:
School's Professor First and Last Name:
Number of Unique Students Enrolled During the Academic Year:
Maximum Number of Students Enrolled Concurrently:

Length of Academic Term:

In Weeks

 

Coverage Section

Type of Operations:

Annual Gross Production Cost:
Maximum Budget Per Production:
Maximum Days Per Production:
Rental Operations Revenue:

Shooting Locations:

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

Category   Number

 

 

 

 

 

 

Effective Date:

Annual Policy Period

 

Inland Marine

Property & Equipment Coverages

Rented Equipment:

Camera, Lighting, Sound, Etc.

Owned Equipment:

Rented Props, Sets & Wardrobe:

Negative Film, Videotape & Digitized Image:

Same Limit as Faulty Stock

Faulty Stock:

Extra Expense:
Third Party Property Damage:
Office Contents:

Rental Cost Reimbursement:

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

Waiver of Subrogation:

 

General Liability
Occurrence / Aggregate Limit:
Fire Legal:
Medical Payments:

Blanket Additional Insureds / Certificates of Insurance:

Included

Blanket Additional Insureds allow for unlimited certificates to vendors and locations. City certificates, other special certs, and waivers of subrogation are picked up under their respective coverages.

City/Other Special Certificates:

Included

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

Waiver of Subrogation:

Included

Primary & Non-Contributory Wording Occasionally Required by Locations.

 

Automobile - Hired & Non-Owned

Liability:

Physical Damage:

Occurrence / Aggregate

Deductible Options:

Cost to Hire Vehicles:

Number of Loaned or Donated Vehicles / Days:

# of Vehicles

# of Days

 

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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