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 ProductionInsurance.com

  A Service of Supple-Merrill & Driscoll, Inc.

 

  

 

 Photographers, Videographers, DJ's 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 Information

Operations:

Description of Business / Operations:

 

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

 

Location Information
Alarm Type:
Alarm Monitoring Company:

 

General Information for DJ's
Estimated Annual Revenue:
Estimated Number of Events for Next 12 months:
% of Events at Private Functions:
% of Events at Public Functions:
Number of DJ's:
Number of Employees:

 

General Information for Photographers & Videographers

Annual Gross Production Cost/Revenue:
Estimated Number of Shoots for Upcoming 12 Months:
Maximum Budget Per Shoot:
Maximum Days Per Shoot:
% of Shoots at Private Functions:
% of Shoots at Public Functions:
Number of Photographers / Videographers:
Number of Employees:

 

Foreign Operations for Photographers & Videographers
Aggregate GPC for Shoots Outside U.S. & Canada:
Number of Shoots Outside U.S. & Canada:
Aggregate Days Shooting Outside U.S. & Canada:

 

Coverage Term

Effective Date:

Annual Policy Period

 

Inland Marine

Property & Equipment Coverages

Owned Equipment, Props, Sets, Wardrobe:
Equipment, Props, Sets, Wardrobe Deductible:
Rented Equipment:
Rented Props, Sets, Wardrobe:

Rented Furs, Jewelry, Art & Antiques Coverage:

 

The Props, Sets & Wardrobe form provides up to $25,000 for furs, jewelry, arts, antique coverage. If a higher limit is required, include the additional limit under this coverage. A schedule/appraisal of the item(s) will be required.

Negative Film, Videotape, & Digitalized Image:

Faulty Stock:

Library Stock Coverage:

Expands the definition of negative film, videotape and digitalized image to include insured's original cut negative film of completed or released productions, duplicate negatives, completed video tapes or other related media.

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

Rental Cost Reimbursement:

Limit Per Day

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

EDP:

Electronic Data Processing Equipment

.Computers and related equipment, media, software. Software extra expense is automatically included up to 25% of the hardware limit.

Limited Computer Virus:

Attaches to EDP and provides limited coverage for computer viruses.

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

 

General Liability

(Required)

Limits:

Occurrence / Aggregate

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:

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

Waiver of Subrogation:

Primary & Non-Contributory Wording Occasionally Required by Locations

Employee Benefits Liability:

 

Automobile

Hired & Non-Owned Liability:

Hired & Non-owned Auto Physical Damage:

Per Vehicle / Aggregate Limit

Waiver of Subrogation:
Number of Loaned or Donated Vehicles / Days:

 # of Vehicles

# of Days

Cost of Hire:

Mobile Studios and Film Trucks

Other Than Mobile Studios and Film Trucks

 

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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