Insurance Form

Special Event Insurance

Event Location

Coverage Length

Combined Daily Attendance

people

What type of event is it?

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1 Basic Event Details

What type of event is it?

Where is your event?

Total days of coverage you need

Combined Daily Attendance

people

2 Eligibility Questions

Are there water activities, amusement devices, inflatables, rides or animals?
YesNo

I understand there is no coverage for water activities, amusement devices, inflatables, rides or animals.
YesNo

Is there camping, sleeping overnight or events past 2am? (If going past 12am, be sure the following day is included in your date selections above.)
YesNo

Will you or anyone under your direction be operating a golf cart, ATV or UTV?
YesNo

Will your event(s) be a political event, activist event, protest, rally or march?
YesNo

Have you or anyone involved in the Event had more than 1 Event Liability Claims/Losses or any Event Liability Claim/Loss valued over $10,000 in the past 5 years?
YesNo

Will you, the insured, your operations, your products, or your event participation have any involvement with cannabis or cannabis-related products?
YesNo

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3 General Liability Coverage Options

Alcohol Coverage

Coverage Limits

Need a Waiver of Subrogation?
YesNo

Need Hired & Non-Owned Auto?
YesNo

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4 Dates of Coverage

I understand that the dates selected above are the only dates that will be covered by this policy. Each date is midnight to midnight. I have selected all set-up and clean-up days necessary for my event.

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5 Your Name & Address (Event Holder)

First & Last Name

Your Business Name (optional)

Insured's Address (Your Address)

Phone Number

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6 Event Location / Additional Insured 1

Name of Certificate Holder

Certificate Address

Contact Email (optional)

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