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  10736 Jefferson, Suite 1042
  Culver City, California 90230
  310-216-9152
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Home
Programs
Support
- Support content
  10736 Jefferson, Suite 1042
  Culver City, California 90230
  310-216-9152
  support@insurevents.com
  Fax Toll Free: 866-824-6894
  CA License # 0D75425
  Licensed In All States
  
  Resources
  
  Payment Terms
  
  FAQ
  
  Upload A Document
  
  Forms & Applications
  
  Client Services
  
  Pay My Premium
  
  Request A Certificate
  
  Change My Policy
  
  Report A Claim
  
  Send A Note
  
  Name*
  Email*
  
  Message*
  Email
  This field is for validation purposes and should be left unchanged.
  
  This iframe contains the logic required to handle Ajax powered Gravity Forms.
Make A Payment
Search

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Film Insurance Application

Step 1 of 5

20%

Policyholder Information
Your Company Name
Your Full Name*
Address*
Street Address City State ZIP Code
Primary Phone Number (Preferably Mobile)*
Can this phone accept texts?
- Yes
- No
Click Yes if you would like reminder texts about your quote & policy.
Secondary Phone Number
Can this phone accept texts?
- Yes
- No
Email (If you are an insurance broker, use your email & not your clients)*
Enter Email Confirm Email
Website
How many years of experience do you have?*
Who referred you to us?
Are you a Non-Profit Corporation?
- Yes
- No
Are you an insurance agent/broker applying for a quote on behalf of your client?*
- Yes
- No
For Insurance Agents & Brokers Only
Your Insurance Agency Name
Agents First Name
Agents Last Name
Address
Mailing Address City State / Province / Region ZIP / Postal Code Country
Telephone
Fax
Remember to enter your email address on the previous screen in lieu of your client's email.

Or, Save what You've Entered So Far and Continue Later

Film Details
Name of Production*
Type of Production*
Shoot Dates*
Policy start date*

This should be the first date you set up or pick up equipment or otherwise need your policy to start.
Policy end date*

This should be the last day you will be on set, or the last day you will have rented equipment or the last day you would otherwise need your policy.
Detailed description of production*
Production Budget*

Or, Save what You've Entered So Far and Continue Later

Locations
Provide details on all shoot locations*
You can upload a copy of your rental agreement below.
Do any of your contracts require a Primary & Noncontributory endorsement?*
- Yes
- No
Do any of your contracts require a Waiver of Subrogation endorsement?*
- Yes
- No
What Per Occurrence limit do you need us to quote? found in your location contracts)*
What Aggregate limit do you need us to quote? (found in your location contracts)*
Who is supplying security*
Is security armed?*
- Yes
- No
Upload any contract, synopsis, budget, etc. you want us to see.
Acceptable file types: pdf, jpg, gif, png, doc, docx, xls, xlsx. Maximum File Size: 128MB.
Drop files here or

Accepted file types: pdf, jpg, gif, png, doc, docx, xls, xlsx.

Or, Save what You've Entered So Far and Continue Later

Additional Information
Provide details on any stunts, pyrotechnics, aircraft, drones, bodies of water, car races or any other hazardous activity*
Your previous Insurance company*
Premium Paid
List any previous claims*
Upload a copy of your event flyer or advertisement (Unless your website shows your ad).
Acceptable file types: pdf, jpg, gif, png, doc, docx, xls, xlsx. Maximum File Size: 128MB.
Drop files here or

Accepted file types: pdf, jpg, gif, png, doc, docx, xls, xlsx.
Any additional information we need to know?

Or, Save what You've Entered So Far and Continue Later

Options That Can Be Added To your Policy
Would you like a quote for Rented/Borrowed Auto Liability?*
- Yes
- No
Number of vehicles you will rent or borrow?*
Your cost to rent the vehicles?*
Are all drivers at least 25 years old?*
Any vehicles seat more than 12 persons?*
What will the vehicles be used for?*
Would you like a quote for Rented &/or Owned Equipment?*
- Yes
- No
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?*
Date rented equipment is being picked up*
Date the last of the equipment is returned*
Would you like a quote for Workers' Compensation?*
- Yes
- No
Number of workers*
Payroll,*
Describe workers' duties*
Your Federal I.D. Number*
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*
Would you like a quote for 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*
Would you like a quote for Rain (Weather) Insurance?*
- Yes
- No
Coverage Date(s)*
Policy Limit*
Coverage Time Begins*
Coverage Time Ends*
Would you like a quote for Event Cancellation/Non-Appearance Insurance?*
- Yes
- No
For outdoor events, is the performance area under a cover/roof? Explain.*
Budgeted Total Gross Receipts?*
Phone
This field is for validation purposes and should be left unchanged.

Or, Save what You've Entered So Far and Continue Later

10736 Jefferson, Suite 1042
Culver City, California 90230

310-216-9152
support@insurevents.com

CA License # 0D75425
Licensed In All States

Support

Payment Terms
FAQ
Upload A Document
Forms & Applications

Client Services

Pay My Premium
Request A Certificate
Change My Policy
Report A Claim

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