Quote or Policy - Coverage Add-On You’ve requested that we add coverage to your quote or policy. This is the place to give us the information we need to quote you: Quote or Policy Number (if any) Policyholder Company Name Your Full Name* Phone Number*Email (If you are an insurance broker, use your email & not your clients)* Enter Email Confirm Email Instructions 1. Simply click yes on any of the options below you want us to quote. 2. Answer the questions that appear. 3. Click the Submit button. Liquor Liability*Strongly recommended if you hold a liquor license, or are receiving ANY monies, including door receipts, from anyone (including caterers, bars, etc.) based on alcohol sales. Yes No Are you directly selling, serving, or sharing income from the sale of alcohol?* Yes No Estimated total liquor sales?* Name on Liquor License* How will you prevent serving minors & the intoxicated?* Describe the training & experience of persons serving alcohol* Average age of attendees?* Average cost of a drink?* Number of patrons you will serve?* Non-Owned & Hired Automobile Liability*This insurance only covers liability, not physical damage (collision or comprehensive). We recommend you purchase collision damage waiver coverage from the rental company. Yes No Number of vehicles you will rent or borrow?* Your cost to rent the vehicles?*Our insurance does not cover collision or comprehensive. We recommend you purchase a collision damage waiver from the rental co. Are all drivers at least 25 years old?* Any vehicles seat more than 12 persons?* What will the vehicles be used for?* Rented &/or Owned Equipment* Yes No Date rented equipment is being picked up* MM slash DD slash YYYY Date the last of the equipment is returned* MM slash DD slash YYYY Description of all equipment* Describe protection / security at principal location* Total Value of RENTED Equipment/Sets/Props/Contents?* Total value of OWNED equipment/Sets/Props/Contents?* Workers' Compensation* Yes No Number of workers* Payroll, only for this event(s)* Do not put annual payroll here unless you are requesting an annual quote. Only put the payroll for the duration of your event (including set-up and tear-down).You must also include the amount you are paying subcontractors unless they have their own workers' compensation insurance. You will need to keep on file their certificate of insurance if they tell you they have a policy.Your Federal I.D. Number* Describe workers' duties* Name & Title of an owner or corporate officer*You and all other owners, officers and directors of the company will be excluded from coverage. Social Security Number*xxx-xx-xxxx Format Volunteer / Staff / Performer Accident Medical*This coverage is not a substitution for workers' compensation insurance. See above. Yes No Number of Daily volunteers?* Number of Daily staff?* Number of Daily Performers?* Describe what duties the volunteers will have* Rain (Weather) Insurance*Requires 10 days advance purchase. Yes No Coverage Date(s)* Policy Limit* Coverage Time Begins* Coverage Time Ends* Event Cancellation/Non-Appearance Insurance*Requires you to submit at least 21 days in advance of your event date. Yes No For outdoor events, is the performance area under a cover/roof? Explain.* Budgeted Total Gross Receipts?* Budgeted Total Expenses?* Upload any related documents you want us to seeAcceptable file types: pdf, jpg, gif, png, doc, docx, xls, xlsx. Maximum File Size: 128MB. Drop files here or Select files Accepted file types: pdf, jpg, gif, png, doc, docx, xls, xlsx, Max. file size: 256 MB. Any additional information we need to know?CommentsThis field is for validation purposes and should be left unchanged.