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  A Service of Supple-Merrill & Driscoll, Inc.




 Rental House 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:

Full Name of Contact:
Street Address:
City, State: ,
Zip/Postal Code:


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

Applicant Type:


Underwriting Information

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


General Information

Years of Industry Experience:

Type of Equipment Rented to Others:
Cameras, Lenses Wardrobe
Lighting Vehicles
Sound Generators
Props Other
Check All That Apply
Types of Products Sold:
Cameras Wardrobe
Lenses Misc. Film Gear
Lighting Other
Stock No Products Sold
Check all that apply or select No Products Sold.
Hours of Operation:

From To

Number of Employees:

Maximum Equipment Value Per Rental:

Number of Rentals Per Year:

Average Rental Duration (days):



  Previous 12 Months

Upcoming 12 Months

Rental Revenue:

Sales of Product Revenue:

Other Revenue:


All equipment is registered in an automated system:

Yes  No

Rental contract is used that transfers responsibility for loss, damage, theft, liability to the renter:

Yes  No

Rental Contract contains a hold harmless clause:

Yes  No

Credit checks obtained on customers:

Yes  No

Certificates of insurance required naming rental house as additional insured and loss payee before releasing equipment:

Yes  No

Credit Card is run for all rentals:

Yes  No

Require and verify references:

Yes  No

Contact customer's insurance broker to verify limits and coverages:

Yes  No

Any Installation, staging, rigging, design, construction?

Yes  No

Operators provided with equipment: What percentage of rentals include operators?

Operators provided with equipment: Equipment remains with operators:

Yes  No

Not Left with 3rd Parties

Valid identification required before releasing equipment:

Yes  No


Location Details

Street Address:
City, State: ,
Zip/Postal Code:


Property Info
Year Built:
Construction Type:
Area Occupied:

In Square Feet

Alarm Type:
Alarm Monitoring Company:
Sprinkler System: Yes  No
Protection Class:
Maximum Value of Equipment/Inventory at this location:


Coverage Term

Effective Date:

Annual Policy Period


Inland Marine

Property & Equipment Coverages

Owned Equipment, Props, Sets, Wardrobe:

Equipment, Props, Sets, Wardrobe Deductible:

Rented Equipment, Props, Sets, Wardrobe:

Office Contents:

Office contents and related equipment, furnishings, fixtures, improvements & betterments, inventory.

Office Contents:

Property in Storage

Business Income/Extra Expense:

Resumption of Business Operations:

Extra expense sustained due to the necessary suspension of business operations including relocation expenses and costs to equip and operate any replacement or temporary location.

Loss or Rental Income Coverage:

Covers the potential lost rental income that may ensue subsequent to a loss by their client(s).

Rental House Errors and Omissions:

Provides coverage if items are rented and you or your representatives inadvertently fail to execute the required contract or agreement (only applies when your standard operating procedures require the use of a contract or agreement).


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


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


Due to capacity constraints, limits above 250,000 will require carrier approval.


General Liability


Occurrence / Aggregate Limit:
Fire Legal:
Medical Payments:

Blanket Additional Insureds / Certificates of Insurance:


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:



Hired/Non-Owned Liability:

Hired & Non-owned Auto Physical Damage:

Per Vehicle / Aggregate Limit

Waiver of Subrogation:

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.

Number of Loaned or Donated Vehicles / Days: # Vehicles 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.







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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