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Same Day Quote &
Issue |
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Call
Toll Free 1-800-874-9191
Fax
480-452-0593
www.EQGroup.com |
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For no-obligation
Special Event insurance quote, please complete
the following form
USE THE TAB
KEY TO MOVE BETWEEN FIELDS |
| Insured Name |
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| Address
1 |
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| Address 2 |
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| City |
|
| State |
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| Zip |
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| Country |
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| Entity Type |
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| Name &
Title of Principals |
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| Years Experience |
|
Primary
Contact Information |
| Contact Name |
|
| E-mail
Address |
|
|
Business
Phone Number |
-
(Area + Number) |
| Fax
Number |
-
(Area + Number) |
| Cell Phone
Number |
-
(Area
+ Number) |
| Website
(If Any)
http:// |
|
|
|
| Event Name |
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| Brief description of event |
|
| What are the dates of the
event? |
| Start |
|
|
|
| End |
|
|
| |
| What is the cost / budget of your
event? |
$
|
|
Live Music /
Concerts?
Celebrity /
Artist Name |
|
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Venue Details
(Location where event takes place): |
| Venue Name |
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| Venue Address
|
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| Venue City |
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| Venue State |
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| Venue Zip |
|
|
Attendance |
| Average Daily Spectators |
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| Total Number of
Event Days |
|
| Total
Event Spectator Attendance |
|
| # of Exhibitors (No Sales) |
|
| # of Concessionaires (Non Food
Sales) |
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| # of Concessionaires (Food Sales) |
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|
# of Attractions (Performers) |
|
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Additional
Coverage Options
— in addition to General
Liability do you require : |
| a.
Additional Insured Endorsement? |
|
b. Liquor
Liability Endorsement?
(Host Liquor Included in
Basic Policy)
Dram Shop
Liability - Total Liquor sold for profit |
$
<- if Yes,
enter gross sales |
| c. Waiver of
Subrogation endorsement? |
|
| d. Hired &
Non-Owned Auto
Liability? |
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| e. Third-party
Property Damage
coverage? |
|
| f.
Excess Liability? |
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| g.
Event Cancellation Coverage needed? |
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| h. Rented
Equipment coverage
needed? |
$
<- if yes, enter total
replacement value |
| i. Participants
Medical Coverage? |
<- if
Yes, enter number of average
daily participants |
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Underwriting Questions |
|
1.
Underwriting Questions |
| a. Does
the event include any Stunts, Pyrotechnics, Aircrafts, Animals, Hazardous
Activities, Car Races, Precision Driving, Injury to
Participants, Mechanical Devices, Owned Equipment,
Private Armed Security Guards, Events outside U.S., Film
Production, Rides, Water Activities. |
|
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b. Where will the event be held? |
|
| c. The
event will only take place in the United States ? |
|
| d.
Confirm only one event will be
covered per policy. |
|
| e. Any armed private security
guards? |
|
| f. Is
event for and/or include a nationally known/recognized
person? |
|
| g. Any
inflatable bouncing devices used? |
|
|
2.
Claim History |
| Any prior event with any losses of
any kind declared by the insured and/or known by the
broker? |
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How did you hear about us? |
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| AFIG
Producer - Please enter Name & Number |
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08-01-12 09:45 |
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Insurance Definitions |