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  10736 Jefferson, Suite 1042
  Culver City, California 90230
  310-216-9152
  support@insurevents.com
  Fax Toll Free: 866-824-6894
  CA License # 0D75425
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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*
  Name
  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
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Sports Liability & Medical Package Application

Step 1 of 5

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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

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)*

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*

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)*
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*
Admission charge for this event*
Budget/Cost for this event*
Estimated Gross Receipts*

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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?*
- Yes
- No
Does the contract require a Waiver of Subrogation endorsement?*
- 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
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.
Provide details of all of your other locations*

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

Additional Event Details
List anyone else you need named as Additional Insured on your policy
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, rides or other hazardous activities?*
- Yes
- No
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 the sale or serving of alcohol? (Liquor Liability)*
Recommended if you hold a liquor license, or are receiving ANY monies, 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?*
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?*
Budgeted Total Expenses?*
Would you like a quote for an Annual Policy?*
- Yes
- No
Estimated number of events over the next 12 months?*
Average Attendance per event?*
For each event provide us with Event Name/Type of Event/Event Dates/Total Attendance Per Event*
Comments
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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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