Film Application – Insurevents

Policyholder Information
Your Company Name

The company name on the policy should be the same legal entity signing the permits/location contracts, if any.
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This is NOT the place to put the name of your production. You will be asked for that information on the next screen.
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Insurance Brokers- DO NOT put your name here. You will be asked for that information on the next screen.
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
Hidden
obsolete 8-20-19
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

Remember to enter YOUR email address above, NOT your client's email. Otherwise they will receive automatic notifications and our quote instead of you.
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.

Film Details
Name of Production*
Type of Production*
Shoot Dates*
Policy start date*
MM slash DD slash YYYY

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

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*
Maximum number of persons on set each day*

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?*
Higher rates apply if you need it.
- Yes
- No
Do any of your contracts require a Waiver of Subrogation endorsement?*
Higher rates apply if you need it.
- 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)*
List anyone you need to name as Additional insured
Extra premium will apply to anyone other than sites/locations.
Who is supplying security*
Is security armed?*
- Yes
- No
Upload any contract, synopsis, budget, equipment list, 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, Max. file size: 256 MB.

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, Max. file size: 256 MB.
Any additional information we need to know?

Policyholder Information