Please provide your FIA Agent Member #
As a member, your contact information is saved and automatically applied to your quotes.
First Name
Last Name
Agency Name
Commission Structure
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Please provide the contact information for the named insured.
This will be reflected on the quotation as well as the certificates.
Date of Quotation Submission
/
Month
/
Day
Year
Date
Applicant's Name
First Name
Last Name
Named Insured
Named Insured Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Will the named insured's event be taking place at an indoor or outdoor Venue
*
Indoor
Outdoor
Both
Select the type of indoor event for quotation
Please Select
Anniversaries
Auctions
Bingo
Concerts/Music Festivals (Recitals, Youth Choir, Etc.)
Exhibitions (No sports, motor sports, or rodeos)
Fashion Shows
Film Screenings
Fundraisers
Galas
Instructional Classes (Not Sports Related)
Indoor Meetings/Conferences
Musical, Plays, Book Readings, Theater Performance
Seminars
Social Gatherings (Indoors)
Speaking Engagements
Weddings
Please note we are not able to offer instant quotations for all forms of special events and spectator liability as an instant quote due to their complex nature. If a particular event is not listed please contact ifrazier@frazierinsurance.com to receive a comprehensive quotation.
Select the type of outdoor (or both) event quotation
Please Select
Adult Soccer (Spectator Only)
Animal Shows/Training
Art Festivals
Auto Shows (Static Display Only)
Block Parties/ Social Gatherings (Outdoor)
Boxing (Spectator Only)
Brewing Events
Concerst/Music Festivals (Blues, Classical, Country Western, Folk, Gospel, Jazz)
Craft/Trade Shows
Dances
Festivals/Carnivals
Flea Markets
Horse/Cattle Shows
Outdoor Meetings
Parades
Sports Events (Spectator Only)
Talent Shows
Wine Shows
Please note we are not able to offer instant quotations for all forms of special events and spectator liability as an instant quote due to their complex nature. If a particular event is not listed please contact ifrazier@frazierinsurance.com to receive a comprehensive quotation.
What type of coverage do you need?
Single Day Coverage
Multi-Day Coverage
What date will coverage begin?
/
Month
/
Day
Year
Date
What date will coverage end?
/
Month
/
Day
Year
Date
What is the estimated total attendance?
To the best of your knowledge has the named insured or the event itself had a prior insurance claim?
Yes
No
Is applicant responsible for the sale of alcohol?
Yes
No
If yes, please provide total estimated liquor receipts from the sale of alcohol.
FIA does not offer coverage for BYOB events
Is Non-Owned/Hired Automobile coverage required?
Yes
No
Auto Yes
Expiration Date
-
Month
-
Day
Year
Date
Outdoor Basic Premium
Indoor Basic Premium
Rate + LL
Quote
Total Due
Total Due Less Commission
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