Equipment & Property Insurance Application Step 1 of 3 33% Policyholder InformationYour Company NameYour Full Name*Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Phone Number (Preferably Mobile)*Can this phone accept texts?YesNoClick Yes if you would like reminder texts about your quote & policy.Secondary Phone NumberCan this phone accept texts?YesNoEmail (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 an insurance agent/broker applying for a quote on behalf of your client?*YesNoFor Insurance Agents & Brokers OnlyYour Insurance Agency NameAgents First NameAgents Last NameAddressIf you're one of our regular brokers, you can skip this part. We'll look you up by your name and email. If you're new, or your address information has change, please continue. 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Or, Save what You've Entered So Far and Continue Later DetailsType of Business (Promoter, Sound & Light, Artist, etc.)*First date property will be in your possession* Last date property will be in your possession* Total Value of RENTED Equipment/Sets/Props/Contents?*Total value of OWNED equipment/Sets/Props/Contents?*Description of all equipment*Principal Storage Location*Will the property be in your possession at all times?*If property is stored overnight explain how it will be kept safe*Will you be transporting the property at any time?*Does any of your equipment go underwater?*Will you travel outside of the U.S. with your equipment?*Upload a copy of your property schedule which must include Make, Model, & Serial # of all OWNED items valued at more than $500.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. Do you rent your equipment to others?*YesNoWhat is the total value of the equipment you rent to others?*Your previous Insurance company*Premium paidList all previous claims* Or, Save what You've Entered So Far and Continue Later OptionsFor RENTED equipment would you like to cover continued rental fees in case of a claim?*YesNoIf you have a covered claim, this coverage reimburses your rental company for their loss of rental income during your claim handling. The rental company will generally make you responsible for their lost rental opportunity. This coverage has a 72 hour waiting period from the time the claim is reported in writing to us.Total cost to rent your equipment*For OWNED equipment would you like to cover the cost to rent replacement equipment in the event of a loss?*YesNoIf you have a covered claim, this coverage reimburses your rental fees for replacement equipment rented to continue your project.Estimated cost to rent replacement equipment to complete your project.*CommentsThis field is for validation purposes and should be left unchanged. Or, Save what You've Entered So Far and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.