Vendor Application – Insurevents

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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
  Licensed In All States
  
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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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Vendor Liability Purchase

Step 1 of 4

25%

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
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?*
Are you a Non-Profit Corporation?
- Yes
- No
Who referred you to us?
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

General Information
Products Sold/Exhibited*
Size of selling area (in feet)*
Estimated attendance at your booth*
Start Date of Your Policy (First Set-Up Date)*
Which Policy Term are you purchasing?*
- 5 Days / $175 Premium
- 14 Days / $250 Premium
- 1 Month / $300 Premium
- 6 Months / $425 Premium
- Annual / $500 Premium
Are you involved in any of the following: Body piercing or tattooing; Fireworks sales & displays; Hot wax impressions; Live animals; Massage; Medical testing; Motor sports activities; Nutritional/health supplements; On-site installation/service/repair of products; On-site equipment rental; Oxygen; Aromatherapy; Time share sales; Tobacco products; Vehicles in motion; Watercraft exhibits on water; Weapon sales; Weight-loss plans or products; Medical marijuana and/or paraphernalia; Catering Companies; Christmas tree lots; Corn or Hay mazes; Disc-Jockeys for events with over 200 attendees; Haunted attractions; Live Bands; Mechanical or inflatable amusement devices; Food Truck.*
If yes, provide full details in the note section below.
- Yes
- No
Your previous Insurance company*
Premium Paid
List any previous claims*

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Information on your 1st upcoming event
Name of Event or Description*
Event Dates*
Name of Location or Promoter*
Their Contact's First & Last name*
Contact's Email
Their Telephone
Fax
Address*
Mailing Address City State / Province / Region ZIP / Postal Code Country
Venue's/Promoter's additional insured wording (found in your rental agreement)
Does the contract require a Primary & Noncontributory endorsement?*
- Yes
- No
Does the contract require a Waiver of Subrogation endorsement?*
- Yes
- No
Upload a copy of your vendor contract with the Promoter/Location
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?

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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*
Name
This field is for validation purposes and should be left unchanged.

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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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