Home | Client Services | Claims | Contact Us

 
 

        

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

 

  

 

 Foreign Production Package Application Instructions

  1. Please complete and submit this 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:

 

Qualification Questions

Are there any planned activities involving any of the following special

hazards: Stunts, Pyrotechnics, Use of Aircraft, Interaction

with Wild Animals, Operation or Control of Watercraft?

Yes  No
Will there be any filming whereby you will have
control over the use of public roadways?
Yes  No
Any bankruptcies in the last 5 years? Yes  No

 

Coverage Section

Operations:
Description of Business/Operations:
Total Budget:
Title:
Production Type:

Country / Shooting Location(s):
Additional Location Details:

Synopsis:

Input a brief description of the shoot.

Coverage Term:

to

Up to 1 Year

Number of Episodes:

Length of Episode:

Total Number of Shoot Days:

 

Music Video Details

Only if Shoot is a Music Video

Music Category:
Music Decade:
Artist Name(s):

 

Loss History

Any Prior Production With Any Losses of Any Kind?

 

Entertainment Production Package

General Liability:

Occurrence / Aggregate

Waiver of Subrogation:

Primary & Non-Contributory Wording Occasionally Required by Locations

 

Contingent Automobile Liability
Hired/Non-Owned Liability:

Auto Physical Damage:

Any One Accident / Policy Aggregate

 

Employers Responsibility

Workers' Compensation for US Nationals

Benefits for Voluntary Compensation-North Americans:
Number of Employees from US and/or Canada:
Maximum Number of Employees per Flight:

Please contact us for Workers Compensation for Foreign Nationals.

 

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.

 

Inland Marine

Property Coverages

Unscheduled Owned Equipment:

Rented Equipment, Props, Sets & Wardrobe:

Negative Film/Faulty Stock: $25,000
Worldwide Coverage: Included
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:

 

 

 

  

Home | About Us | Client Services | Sitemap | Claims | Blog | Contact Us

Productions | Entertainment Services | Events | Floaters | Errors & Omissions | Instant Quotes

 

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

Copyright 2017.  All rights reserved.  Terms of Use | Privacy Policy