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

  

  

 

 Single Foreign Special Event 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. Cancellation coverage cannot be quoted less than 14 days prior to the event.

 

  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:

 

Event Details

Event Name:
Event Cost/Budget:
Event Classification:
Detailed Event Description:

If a Music Festival, How Many Bands:

Music Category:

If Any

Hold Ctrl to select multiple categories.

Event Date(s):

to

Please list non-consecutive dates in the Notes section below.

Event Time:

 to

Number of Days:

Medical or EMS Available:

Athletic Events

Is event for and/or include a nationally known/recognized person?

Private Armed Security Guards:

Private Armed Security Guards make the event ineligible for our program.

 

Venue Details

Location Where Event Takes Place

Venue Name:
Address:
City:
Country / Event Location(s):
Additional Location Details:
Event Location:

 

Attendees

Average Daily Spectators:

Average Daily Participants:

Athletic /Theatrical Participants

 

General Liability 

General Liability:

Occurrence/Aggregate

Liquor Liability:

Recommended for Events with Alcohol

Waiver of Subrogation:

Included

 

Contingent Automobile Liability

Hired/Non-Owned Liability:

Hired/Non-Owned Auto Physical Damage:

Occurrence / Aggregate

 

Inland Marine

Property Coverages

Unscheduled Owned Equipment:
Rented Equipment, Props, Sets & Wardrobes:
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:

 

 

 

  

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

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