Sports Application – Insurevents

Policyholder Information
Your Company Name

The company name on the policy should be the same legal entity signing the permit/rental contract, if any.
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This is NOT the place to put the event name. 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.
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
Remember to enter your email address on the previous screen in lieu of your client's email.

Event Details
Name of Event*
Indoors or Outdoors?*
Type of Sport (Camp, Bike Race, Triathlon, Team, etc.)*
Event Dates*
Event Start Time*
Event End Time*
Everyone off the grounds by midnight?*
- Yes
- No
Start Date of Your Policy (First Ste-Up Date)*
MM slash DD slash YYYY

This should be the first date you set up, or the first date you otherwise need your policy to start.
What is the Last Date You Will Tear Down & Load Out*
MM slash DD slash YYYY

This should be the last day you will be on location or the last day you would otherwise need your policy.
Detailed Event Description*
Number of participants Daily (specify the number for each event day)*
Number of spectators Daily*
For multiple day events, are the participants the same persons each day?*
- Yes
- No
How many are under the age of 18?*
Age of youngest participant*
Age of oldest participant*
Do you require participants to sign a Liability Waiver?*
- Yes
- No
If you do not require waivers, we cannot insure injury to participants. Your quote will only include coverage for injury to spectators. Participant injuries will be excluded. To insure injury to participants, you must have every participant sign a waiver.
Admission charge for this event*
Budget/Cost for this event*
Estimated Gross Receipts*

Venue/Site Information
Name of Venue*
Venue Contact's First & Last name*
Venue Contact's Email
Venue Telephone
Venue Fax
Address*
Mailing Address City State / Province / Region ZIP / Postal Code Country
Venue's additional insured wording (found in your rental agreement)
You can upload a copy of your permit/rental agreement below.
Does the contract require a Primary & Noncontributory endorsement?*
Higher rates apply if you need it.
- Yes
- No
Does the contract require a Waiver of Subrogation endorsement?*
Higher rates apply if you need it.
- Yes
- No
What Per Occurrence limit does the venue require (found in your rental agreement)*
What Aggregate limit does the venue require (found in your rental agreement)*
Who is supplying security*
Is security armed?*
- Yes
- No
Type of Security (Uniform, peer group, ushers, etc.)*
How many of each*
Type of seating (folding, bleachers, standing, / reserved, general admission*
Upload a copy of your permit/rental contract
OPTIONAL but will tell us pretty much everything we need to know on how to structure your policy. 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.
Provide details (including addresses) of all of your other locations*

Additional Event Details
List anyone else you need named as Additional Insured on your policy
Additional premium will apply. Include name, any specific wording, complete address and relationship to event.
Describe First Aid / Medical Arrangements*
If you have vendors / subcontractors providing any of these services you should also get named on their policy as an additional insured.
Are Participants required to sign a Waiver of Liability?*
- Yes
- No
Any stunts, pyrotechnics, aircraft, car races, golf carts, rides or other hazardous activities?*
- Yes
- No
Provide full details of the activities*
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).
Optional. 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