Production Portfolio Application Instructions

( indicates required information)

Applicant Information

< select > Corporation Individual Joint Venture Limited Liability Corporation Limited Liability Partnership Non-Profit Partnership Trust

Email:

We will never rent, sell, or share your email address.

< select > No Yes

< select > No Yes

< select > No Yes

Confirm your understanding that if coverage is provided, only one production

will be covered by the policy(s) issued.

I Agree  I Disagree

Any insurance declined or cancelled in the past 3 years?

Any loss in the past 3 years?

Any prior insurance coverage?

Production Details

Maximum eligible budget is 30,000,000.

Production Dates:

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If insuring rented equipment start with pick-up and end with drop-off day.

Synopsis:

Input a brief description of the shoot.

Filming Locations

Please choose the territories in which production activities will take place.

< select the country > United States of America Canada American Samoa Guam Northern Mariana Islands Puerto Rico U.S. Virgin Islands < select the state > Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Island Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory

Additional Questions

Will the production include any Stunts, Pyrotechnics, Aircraft, Boats, Animals, Race Tracks, Race Courses, Helicopters, Motorbikes, Snowmobiles, Blanks, Squibs, Guns?

< select > No Yes

Music Video Details

Only if Shoot is a Music Video

Key Production Contact

Foreign entities and/or foreign individuals shooting in the U.S. must have a permanent location in the U.S. or hire the services of a U.S. based producer or executive producer.

< select > Executive Producer Producer

At least 1 producer or executive producer must be scheduled on the production.

Drivers License:

< select > Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

State & Number

Stunt, Animal, Driving or Pyrotechnic Scenes

Click Here to Skip If None

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Animal Injury, Sickness & Death

Animal Type(s):

Alligators Bears Bobcats Camel Cats (Household) Cheetahs Cows Crocodiles Dogs Dophin Ducks Elephant Flamingos Geese Giraffe Goats Hamsters Hippopotamus Horses Jaguars Lambs Leopards Lions Llama Mice Monkey Mountain Lions Ostrich Other Animals (on file with carrier) Parrots Pigs Reptiles (Domestic) Rhinoceros Sea Lions Shark Snakes Swans Tigers Whales

To select multiple animals, please hold CTRL while selecting.

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Inland Marine

Equipment & Property Coverage

Excluded 10,000 w/ 1,500 Deductible 25,000 w/ 1,500 Deductible 35,000 w/ 1,500 Deductible 50,000 w/ 1,500 Deductible 75,000 w/ 1,500 Deductible 100,000 w/ 1,500 Deductible 125,000 w/ 2,500 Deductible 150,000 w/ 2,500 Deductible 175,000 w/ 2,500 Deductible 200,000 w/ 2,500 Deductible 225,000 w/ 2,500 Deductible 250,000 w/ 2,500 Deductible

Excluded 100,000 w/ 1,500 Deductible 150,000 w/ 1,500 Deductible 250,000 w/ 2,000 Deductible 250,000 w/ 2,500 Deductible 300,000 w/ 2,500 Deductible 350,000 w/ 2,500 Deductible 350,000 w/ 3,000 Deductible 400,000 w/ 2,500 Deductible 400,000 w/ 3,000 Deductible 450,000 w/ 2,500 Deductible 450,000 w/ 3,000 Deductible 500,000 w/ 2,500 Deductible 500,000 w/ 3,000 Deductible 500,000 w/ 5,000 Deductible 600,000 w/ 2,500 Deductible 600,000 w/ 3,000 Deductible 600,000 w/ 5,000 Deductible 750,000 w/ 2,500 Deductible 750,000 w/ 3,500 Deductible 750,000 w/ 5,000 Deductible 1,000,000 w/ 2,500 Deductible 1,000,000 w/ 3,500 Deductible 1,000,000 w/ 5,000 Deductible 1,250,000 w/ 5,000 Deductible 1,500,000 w/ 5,000 Deductible 1,750,000 w/ 5,000 Deductible 2,000,000 w/ 5,000 Deductible 2,250,000 w/ 5,000 Deductible 2,500,000 w/ 5,000 Deductible

Rented Furs, Jewelry, Art & Antiques Coverage:

Excluded 5,000 10,000 15,000 25,000 35,000 50,000 75,000 100,000

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.

Faulty Stock Broad Form:

Excluded Included

Broadens the faulty stock coverage by providing coverage for: faulty manipulating or judgment of the camera operator or assistants; error(s) of judgment in exposure, lighting or sound recording; use of incorrect raw film stock or videotape or media/software; and errors in machine programming or instructions to the machine.

Excluded 10,000 25,000 50,000 75,000 100,000

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.

Excluded 5,000 10,000 25,000 50,000 75,000 100,000 125,000 150,000

Limit Per Day. Covers the potential additional expense to rent similar equipment after a loss.

Civil Authority:

Excluded 10,000 25,000 50,000 100,000

Extra expense due to the interruption, postponement or cancellation of an “insured production” that is directly caused by or results from the operation of civil authority. The operation of civil authority must prohibit access due to threat of or actual loss or damage to property allowing access to or use of facilities you occupy or intend to occupy in connection with an “insured production” during the term of coverage.

Agency and Talent Re-Shoot Costs:

Excluded 10,000 25,000 50,000 100,000

Provides coverage for contractually obligated (yet unanticipated) talent, services or facilities costs incurred to reshoot the production after a covered loss.

Strikes or Civil Protest:

Excluded 10,000 25,000 50,000 100,000

As a result of an officially sanctioned strike or civil protest, covers the loss due to the interruption, postponement or cancellation of the production.

Waiver of Subrogation:

Coverage Extension Endorsement:

Cinema Production Enhancement Endorsement:

Worldwide Coverage:

Cast Extra Expense:

Excluded 100% of Budget w/ $10K Ded 100% of Budget w/ $25K Ded 100% of Budget w/ $50K Ded 100% of Budget w/ $100K Ded 75% of Budget w/ $10K Ded 75% of Budget w/ $25K Ded 75% of Budget w/ $50K Ded 75% of Budget w/ $100K Ded 50% of Budget w/ $10K Ded 50% of Budget w/ $25K Ded 50% of Budget w/ $50K Ded 50% of Budget w/ $100K Ded 25% of Budget w/ $10K Ded 25% of Budget w/ $25K Ded 25% of Budget w/ $50K Ded 25% of Budget w/ $100K Ded

Provides extra expense incurred in the completion of a production over and above the normal budgeted costs due to the death or disability (accident or sickness) or kidnapping of any scheduled artist. Cast coverage provides protection from pre-production through production and post-production. All artists must be scheduled in advance and medicals are required for sickness coverage. For coverage on an unscheduled basis, you may also include the 'covered person extension with sickness coverage'.

Covered Person Extension (without sickness):

Excluded Included

Provides accidental injury or accidental death cast coverage without having to schedule artists. If sickness coverage is required for any artists, those artists must be scheduled (a reduced limit for sickness coverage on an unscheduled basis is available under the 'Covered Person Extension with Sickness' coverage). Expands the definition of covered person to include any person necessary for the completion of the insured production.

Covered Person Extension (with sickness):

Excluded 5,000 per person / 25,000 Aggregate 10,000 per person / 50,000 Aggregate 25,000 per person / 100,000 Aggregate

Provides accidental injury, death and sickness coverage without having to schedule artists. Expands the definition of covered person to include any person necessary for the completion of the insured production.

Family Bereavement:

Excluded Included

Expands cast coverage to provide for a bereavement period up to 5 days due to the death of an immediate family member.

Owned Equipment:

Excluded 10,000 25,000 35,000 50,000 75,000 100,000 125,000 150,000 175,000 200,000 225,000 250,000

Unscheduled

City/Other Special Certificates:

Excluded Included

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

Waiver of Subrogation:

Excluded Included

Primary & Non-Contributory Wording Occasionally Required by Locations

Abuse & Molestation:

Excluded 50,000 / 100,000 100,000 / 200,000 500,000 / 1,000,000 1,000,000 / 1,000,000

Each Claim / Aggregate

Excluded 125,000/500,000 w/ 10%, 1,500 min deductible 125,000/500,000 w/ 10%, 2,500 min deductible 250,000/500,000 w/ 10%, 1,500 min deductible 250,000/500,000 w/ 10%, 2,500 min deductible 125,000/1,000,000 w/ 10%, 1,500 min deductible 125,000/1,000,000 w/ 10%, 2,500 min deductible 250,000/1,000,000 w/ 10%, 1,500 min deductible 250,000/1,000,000 w/ 10%, 2,500 min deductible 125,000/2,000,000 w/ 10%, 1,500 min deductible 125,000/2,000,000 w/ 10%, 2,500 min deductible 250,000/2,000,000 w/ 10%, 1,500 min deductible 250,000/2,000,000 w/ 10%, 2,500 min deductible

Per Vehicle / Aggregate

Excluded Included

Primary & Non-Contributory Wording

Hired & Non-Owned Auto Liability is rated based upon the cost to rent vehicles, duration of rentals and the number of vehicles that will be rented.

# of Days

# of Vehicles

Mobile Studios and Film Trucks

Other Than Mobile Studios and Film Trucks

Occurrence / Aggregate Limit:

Excluded 1 million / 1 million 2 million / 2 million 3 million / 3 million 4 million / 4 million 5 million / 5 million 6 million / 6 million 7 million / 7 million 8 million / 8 million 9 million / 9 million 10 million / 10 million

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 Abacus programs.

Guild Members, Non-Guild Members, Aggregate Limit:

Excluded 1mil Guild, 50k Non-Guild, 5mil Agg 1mil Guild, 50k Non-Guild, 10mil Agg 1mil Guild, 100k Non-Guild, 5mil Agg 1mil Guild, 100k Non-Guild, 10mil Agg 1mil Guild, 250k Non-Guild, 5mil Agg 1mil Guild, 250k Non-Guild, 10mil Agg 1mil Guild, 500k Non-Guild, 5mil Agg 1mil Guild, 500k Non-Guild, 10mil Agg

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.

Workers' Compensation

Available in: AL, AR, AZ, CA, CO, CT, DC, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MO, MN, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OK, PA, TN, SC, TX, UT, VA, VT, WV.

In addition, for clients located in the above states, locations can now be added for operations that occur in the following 8 states: AK, DE, HI, MA, OR, RI, SD, WI.

Limits:

Waiver of Subrogation:

Excluded Included

Primary & Non-Contributory Wording

All States Endorsement (other than monopolistic states):

Identification Number:

< select > FEIN (Federal Tax ID) Social Security #

An identification number  is required when binding Workers' Compensation coverage.

Payroll by Class Codes (if any)

Officers

Schedule an Officer:

Locations:

Please provide complete street address for a location in each state.

Although the workers compensation policy includes an all states endorsement, certain states may deny benefits if an address in that state is not scheduled on the policy.

To minimize the chance of a claim denial, please schedule a location in each state that the production will occur.  Only one location in each state is required.

Note: All productions shooting in New York are required by the NY Workers Comp Bureau to schedule a NY Location.

Additional Underwriting Questions

Answering the additional questions below may result in a premium modification credit.

Yes  No

Yes  No

Notes