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

 

  

 

 Entertainment 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:

Applicant Details
Years of Industry Experience:
Operations:

In the business of renting equipment to others:

Yes  No

Description of Business/Operations:

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

Yes  No

Any loss in the past 3 years?

Yes  No

Any prior insurance coverage?

Yes  No

Location Details
Street Address:
City, State: ,
Zip/Postal Code:

Property Info

Protection/Security Security Device:

If equipment schedule is $100,000 or more without an alarm, coverage is still available but a protective safeguard endorsement will apply.

Alarm Company Name:

Prior Carrier Information
Prior Insurance Carrier:

Policy Number:

Expiring Premium:
Expiration Date:

Coverage Term

Annual Policy Period:

Effective Date

Inland Marine

  Owned Equipment Value

  Enter the desired coverage limits. A schedule is not required to obtain a quote, and is required to bind coverage.

     Editing / Post-Production Equipment:
     Recording/Studio Equipment:
     Sound/Location Recording Equipment:
     Musical Instrument/Band Equipment:
     Camera/Production Equipment:

Check here if your Equipment Schedule includes UAVs (drones).

     P.A./Sound Reinforcement Equipment:
     Theatrical Property:
     Props, Sets, and Wardrobe:
  Rented Equipment
     Camera, Lighting, Sound, etc.:
     Props, Sets, and Wardrobe:

Policy Deductible:

  Standard Enhancements

     Rented Furs, Jewelry, Art & Antiques Coverage:

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

     Library Stock Coverage:

     Extra Expense:
     Third Party Property Damage:
     Office Contents:
     Business Income/Extra Expense:

Rental Cost Reimbursement:

Limit Per Day

     EDP:

Electronic Data Processing Equipment

     Limited Computer Virus:

     Accounts Receivable:
     Valuable Papers and Records:
     Money & Securities:
     Waiver of Subrogation:
     Worldwide Coverage:

Coverage Extension Endorsement:

Valuable Papers

25,000

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

Terrorism:

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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