A Service of Supple-Merrill & Driscoll, Inc.




 Short Term Production (Adult Entertainment) 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.

  3. Glossary of Terms.


  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:


Qualification Questions
Will the production include any live gangster rap music?
Will any production activities take place outside of the U.S. and Canada?

Any unprotected or open heights above 15 feet?

Any employees supplied to or from an employee leasing operation (i.e. PEO)?

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

will be covered by the policy(s) issued.

I Agree  I Disagree


Insurance History

Any insurance declined or cancelled in the past 3 years?

Any loss in the past 3 years?

Not applicable in MO

If Yes, please describe.

Any prior insurance coverage?


Production Details

Title of Production:
Production Type:
Total Budget for Production:

Maximum eligible budget is 1,000,000.

For budgets over $1,000,000, please apply in Production Portfolio program.

Production Dates:




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


Input a brief description of the shoot and storyline.


Filming Locations

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

Country / State:

Additional Location Details:


Additional Questions

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


Music Video Details

Only if Shoot is a Music Video

Music Category:
Music Decade:
Artist Name(s):


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.
First Name:
Last Name:

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

Drivers License:

State & Number

Country of Residence:


Inland Marine

Equipment & Property Coverage

Rented Equipment:

Owned 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.

Extra Expense:
Third Party Property Damage:
Office Contents:
Animal Extra Expense:
Rental Cost Reimbursement:

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

Accounts Receivable:
Valuable Papers and Records:
Money & Securities:

Civil Authority:

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:

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:

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:

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

Entertainment Enhancement Endorsement:

  Single Limit by Coverage Blanket Limit (100K)
Agency/Talent Re-Shoot Costs 25,000 / 1,500 Included
Power Supply Interruption 50,000 / 2,500 Included
Civil Authority 50,000 / 2,500 Included
Strikes or Civil Protest 25,000 / 1,500 Included
Library Stock Coverage 25,000 / 1,500 Included
Animal Physical Damage 25,000 / 1,500 Included
Animal Extra Expense 25,000 / 1,500 Included
Equipment Breakdown 25,000 / 1,500 Included
Blanket Coverage n/a 100,000 / 2,500

The figures above represent the Limit / Deductible.

Worldwide Coverage:


Equipment Floater

Owned Equipment:



General Liability
Occurrence / Aggregate Limit:
Fire Legal:
Medical Payments:
Blanket Additional Insured / Certificates of Insurance: Included

City/Other Special Certificates:

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

Waiver of Subrogation:

Primary & Non-Contributory Wording Occasionally Required by Locations

Abuse & Molestation:

Each Claim / Aggregate


Automobile - Hired & Non-Owned
Physical Damage Limits:

Per Vehicle / Aggregate

Liability Limits:
Waiver of Subrogation:

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.

Number of Loaned or Donated Vehicles / Days:

# of Days

# of Vehicles

Cost of Hire:

Mobile Studios and Film Trucks

Other Than Mobile Studios and Film Trucks

Will any bus or van be hired primarily for the purpose of transporting people?: Yes  No
  If yes, due to the inherent auto liability exposure of transporting people, information is required for drivers or any bus or van.
Full Name State Drivers License #


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 Abacus 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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