ProductionInsurance.com
  A Service of Supple-Merrill & Driscoll, Inc.

  

  

 

 Single Show Vendor & Exhibitor 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 Questions

Does the Vendor/Exhibitor's activities include any Stunts, Pyrotechnics,

Hazardous Activities, Mechanical Devices, Rides, Rap/Hip-Hop/Rock/Metal

Music Performances, Massage Machines?

Yes  No

Vendor/Exhibitor will be stationed behind their booth or in a

designated area throughout the event?

Yes  No

Does the Vendor/Exhibitor provide bounce houses or inflatables?

Yes  No

Confirm your understanding that only one exhibitor at one

event will be covered by the policy:

Yes  No

The event will take place in the United States or Canada?

Yes  No

Is vendor responsible for any type of security or maintenance personnel?

Yes  No

 

Risk Details

Operations:
Description of Business / Operations:

 

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?

 

 

Show Details

Show Type:
Show Name:
Show Description:
Exhibitor's Cost / Budget:
Area Occupied:

Square Feet

How Many People Will Visit Your Booth:

Venue Details

Location where the show takes place.

Venue Name:
Address:
City:
State:
Zip:
Show Organizer Details
Name of Organizer:
Address:
City:
State:
Zip:

 

Dates

Setup Date(s):

to

If Any

The period before the event to arrange.

Attendees will not be present during the setup.

Select up to 7 days at no additional premium.

Event Date(s):

to

The duration the actual event will take place (not including setup and teardown.

Attendees will be present during the actual event.

Tear Down Date(s):

to

If Any

The period to dismantle after the event.

Attendees will not be present during tear down.

Select up to 7 days at no additional premium.

Event Hours:  to
Total Number of Days:

 

Inland Marine

Equipment, Props, Sets, Wardrobe (Rented):

Equipment of Others

Equipment, Props, Sets, Wardrobe (Owned):

Replacement Cost

Extra Expense:

Third Party Property Damage:

Hired & Non-Owned Auto Physical Damage:
Waiver of Subrogation:
     Coverage Extension Endorsement:

 

General Liability 

Occurrence / Aggregate Limit:

Fire Legal:
Medical Payments:

Blanket Additional Insureds / Certificates of Insurance:

Included

City / Other Special Certificates:

Waiver of Subrogation:

Primary & Non-Contributory Wording - Only if Required by Locations and Vendors

Terrorism:

Included

 

Automobile

Hired/Non-Owned Liability:

Waiver of Subrogation:

Primary & Non-Contributory Wording

Cost of Hire (mobile studios and film trucks):
Cost of Hire (other than mobile studios/film trucks):
Number of Loaned or Donated Vehicles / Days:

# Vehicles

Days

 

Excess Liability

Per Occurrence/Aggregate Limit:

Terrorism:

Included

 

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:

Primary & Non-Contributory Wording

All States Endorsement:

Included

Other Than Monopolistic States

Identification Number:

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

Payroll by Class Codes:

# Full Time (W2) # Part Time (1099) Total Payroll

9154 - Crew

If Any

Officers Names:

Full Name  Title

Workers compensation coverage is not provided for officers & owners.

Enter the first name, last name and title for each officer/owner.

Exclusions of coverage for stunts and hazardous activities will apply.

 

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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