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 ProductionInsurance.com

  A Service of Supple-Merrill & Driscoll, Inc.

 

  

 

 Shell Corps 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

 

Owner / Principal Information
Owner First Name:
Owner Last Name:
Date of Birth:

Profession of the Owner/Principal:

If Athlete  

Sport:

Team:

If Musician  

Genre of Music:

Name of Band:

Notoriety of Owner:

Class1
None, minimal or minor visibility of wealth, position or notoriety. Limited public recognition.
Class 2
Very visible as to wealth, position or notoriety. Popular or prominent but not a superstar.
Class 3
Superstar. Instant recognition. No adverse public or controversial image.
Class 4 (ineligible)
Superstar. Instant recognition. Associated with controversial image or press.

 

Touring Information
Estimated Annual Payroll:

Only If Touring

Estimated Number of Shows:

Only If Touring

Number of Employees:

 

General
Is the individual involved in any stunts or hazardous activities?

Yes  No

Does the owner/principal have security personnel?

Yes  No

Number of security personnel?

If a third party, is a certificate of insurance obtained?

Yes  No

 

Coverage Term

Effective Date:

Annual Policy Period

 

Inland Marine

Property & Equipment Coverages

Rented Equipment:

Owned Equipment Limit:

Owned Equipment Deductible:

Third Party Property Damage:

Office Contents:

Business Income/Extra Expense:

Hired & Non-owned Auto Physical Damage:

Per Vehicle / Aggregate Limit

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

Earthquake:

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

 

General Liability

(Required)

Limits:

Occurrence / Aggregate

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.

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.

Throwing Objects Exclusion:

The base policy excludes coverage for objects thrown by performers from the stage. This exclusion may be removed, subject to underwriting review.

Comprehensive Personal Liability/Personal Injury:
Workers' Compensation - Residence Employees:
Employee Benefits Liability:

 

Automobile
Hired/Non-Owned Liability:
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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