|
Same Day Quote & Issue |
|
Call Toll Free 1-800-874-9191
Fax
480-452-0593
www.EQGroup.com |
|
For
no-obligation Special Event insurance quote, please
complete the following form
|
| Insured
Name |
|
| Address
1 |
|
| Address
2 |
|
| City |
|
| State |
|
| Zip |
|
| Country |
|
| Entity
Type |
|
| Name &
Title of Principals |
|
| Years
Experience |
|
|
Primary
Contact |
| Contact
Name |
|
| E-mail
Address |
|
| Primary
Phone Number |
-
(Area + Number) |
| Fax
Number |
-
(Area + Number) |
| Cell
Phone Number |
-
(Area
+ Number) |
| Website
(If Any)
http:// |
|
|
Event
Description |
| Event
Name |
|
| Brief
description of event |
|
What
are the
dates of the event? |
| Start |
|
|
|
| End |
|
|
| |
|
What is the cost/budget of your event? |
$
|
|
Venue Details
(Location where event
takes place): |
| Venue
Name |
|
| Venue
Address
|
|
| Venue
City |
|
| Venue
State |
|
| Venue
Zip |
|
|
Attendance |
| Average
Daily Spectators & Participants |
|
| Number
of Days |
|
| Total
Event Attendance |
|
|
Participant Details
|
| # of
Exhibitors (No Sales) |
|
| # of
Concessionaires (Non Food Sales) |
|
| # of
Concessionaires (Food Sales) |
|
|
# of Attractions
(Performers) |
|
|
Liability Options
— in addition to General Liability
do you require : |
| a.
Additional Insured Endorsement? |
|
| b.
Liquor liability? |
|
| c.
Waiver of subrogation? |
|
| d.
Hired & non-owned auto liability? |
|
| e.
Third-party property damage coverage? |
|
| f.
Rented equipment coverage needed? |
$ <- if yes,
enter total replacement value |
| f.
Spectators & Participants Medical Coverage? |
<- if Yes,
enter number of average daily participants |
|
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, Rap/Hip-Hop, Rock/Metal,
Rides, Water Activities. |
|
|
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? |
|
|
How did you hear about us? |
|
| AFIG
Producer - Please enter Name & Number |
|
|
|
Insurance Definitions |