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 ProductionInsurance.com

  A Service of Supple-Merrill & Driscoll, Inc.

 

  

 

 Performers 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. 

 

This is a secure application.  Strong cryptography is implemented via the Secure Sockets Layer protocol.  Our Privacy Policy.

Program Information

 

( 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:

Operations Information

Insured Type:

If a group of performers, please provide name, address and description of each performer.

Number of Performers:
Performer Classification:

Hold CTRL to select multiple Performer classifications.

Times of Performances:
Locations of Performances:
Description of Performances:
Insurance History
Any insurance declined or cancelled in the past 3 years?

Yes  No

Any prior insurance coverage?

Yes  No

Any loss in the past 3 years?

Yes  No

Additional Insured Information
Additional Insured(s):

Include the name and address for each Additional Insured.

Coverage Term

Short Term Coverage:

to

Annual Term Effective Date:

Inland Marine

Property & Equipment Coverages

Owned Equipment, Props, Sets, Wardrobe:

Up to $750,000

General Liability

Limits:

1 million / 1 million

Occurrence / Aggregate

Automobile

Hired/Non-Owned Liability:

Excess Liability

Occurrence / Aggregate Limit:

The excess liability is an additional layer of coverage above the general liability, auto, and employers liability. Note that this excess policy will only sit on top of risks insured through these programs.

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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