*Required
 
Company Information
Paper Version
Company Name  
First Name*
Last Name*  
Address* (No P.O. Boxes)  
City*  
State*  
Zip*  
Daytime Telephone Number*  
Mobile Telephone Number  
Fax Number  

Your Email Address*

 
Your Website Address  
Years Experience*  
General Information
 
Name of Event*  

Type of Event*(Convention, Concert, Sporting Event, etc.)

 
Names of all Performing Artists/Speakers, etc.  
Event Date(s)*  
Event Times * From To  
Detailed Description of Event*  
What Allowance Has Been Made For Travel Delays?*  
Allowance For Set Up Time?*  
Allowance For "Rain" Dates?*  
Venue/Site Information
 
Name of Venue/Location*  
Venue Mailing Address  
City*  
State*  
Zip  
Telephone Number  
Fax Number  
Contact Person (First & Last Name)  
Contact Person Email Address  
Is the event indoors?  
If no, is the performance area under a cover?  
Estimated Total Attendance  
Underwriting Information
 
Would bad weather cause cancellation of your event?  
Will the Event Venue require construction work? If Yes, provide details *  
Will the non-appearance of any individual / group / or team, etc. cause cancellation?  
If Yes, provide details including Names & Dates of Births of all Performing Artists/Speakers, etc.  
Describe the travel itinerary of the individual/group/team. Where are they traveling from? Method of transportation? Date & time of arrival?  

List all previous known claims (Last 5 years) which would have been covered by this type of insurance, had it been in force*

 

 

 
Policy Limits
 
Budgeted Total Gross Revenue*  
Budgeted Total Expenses*  
Net Income (Revenue less Expenses)*  
Application Notes/Additional Information  

Application Warranty & Instructions

I HEREBY WARRANT AND CONFIRM THAT THE ABOVE INFORMATION, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT, AND FURTHER CERTIFY THAT I HAVE READ ALL OF THE QUESTIONS AND ANSWERS OF THIS APPLICATION. I UNDERSTAND THIS APPLICATION IS A REQUIREMENT FOR COVERAGE, A PART OF THE CONTRACT AND EVIDENCE OF MY ACCEPTANCE OF THIS INSURANCE, AND ANY FALSIFICATION OR MISREPRESENTATION WILL BE DEEMED A BREACH OF CONTRACT, VOIDING ALL INSURANCE COVERAGE. IT IS UNDERSTOOD AND AGREED THAT THE COMPLETION OF THIS APPLICATION SHALL NOT BE BINDING EITHER TO THE PROPOSED INSURED OR THE COMPANY UNTIL ACCEPTED BY THE COMPANY OR COMPANIES IN WRITING.

 
Name of person acknowledging Warranty*  
Date of acknowledgment*  
For Insurance Agents & Brokers Only
 
Your Company Name  
First Name  
Last Name  
Address  
City  
State  
Zip  
Daytime Telephone Number  
Mobile Telephone Number  
Fax Number  

Your Email Address