Equipment Rental Insurance Application

Coverage provided:
- Rented Equipment at Limit Selected subject to a $1,000 deductible
- $2,000,000 CND Commercial General Liability
There is no coverage for equipment that is owned by the member nor for equipment designed for aerial photography or operations thereof. Locked Vehicle Warranty - Rented Equipment Coverage is null and void if stolen from unlocked vehicle.
Coverage provided:
- Rented Equipment at Limit Selected subject to a $1,000 deductible
- $2,000,000 CND Commercial General Liability
There is no coverage for equipment that is owned by the company nor for equipment designed for aerial photography or operations thereof. Locked Vehicle Warranty - Rented Equipment Coverage is null and void if stolen from unlocked vehicle.
Which group are you a member of?
Company Name
Member's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Production Details
Director
Producer
Experience of Applicant & Director (examples):
Production Details
a. Type of project (Short, Documentary, Music Video, Etc.):

b. Storyline & action sequences + provided synopsis/treatment:

c. Type of filming (outdoors/indoors/terrain/any special hazards, ie underwater/overwater):

d. Describe all special stunts, scenes involving animals, motorcycles, special vehicles, boats, aircraft, explosives or any special hazardous Activity:

e. Location (City & Province) and number of weeks at each:

f. Will any of the filming be done outside of Canada ? If yes, describe and include estimated duration:
Number of days that you will be requiring insurance:
Start Date of Principal Photography :

MonthDayYear
Date
End Date of Principal Photography :

MonthDayYear
Date
Number of days that you will be requiring insurance:

Date Period(s) of Principal Photography: Date to Date
If shooting in non-consecutive days provide dated of filming ( example 3 weekends over the course of 5 months period):

Dates of Principal Photography:   Date   to   Date
Dates of Principal Photography:   Date   to   Date
Dates of Principal Photography:   Date   to   Date
Dates of Principal Photography:   Date   to   Date
Total Budget ($):
Total Replacement Cost Value of Rented Equipment ($)
Please attach budget:

Cancelof

Rented Equipment
Location to which equipment is returned when not in use:
Indicate Inventory Control Methods and who is responsible:
How will equipment be transported?
List of parties that will be requiring proof of insurance:
Name (Individual or Rental House):
Address:
Replacement Value of Equipment Being Rented: 


Name (Individual or Rental House):
Address:
Replacement Value of Equipment Being Rented: 


Name (Individual or Rental House):
Address:
Replacement Value of Equipment Being Rented: 


Name (Individual or Rental House):
Address:
Replacement Value of Equipment Being Rented: 


Name (Individual or Rental House):
Address:
Replacement Value of Equipment Being Rented: 


Name (Individual or Rental House):
Address:
Replacement Value of Equipment Being Rented:
Liability
Shooting Location:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are there additional shooting locations?
Shooting Location 2:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shooting Location 3:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List of parties that will be requiring proof of insurance:
Legal Name:
Address:

Legal Name:
Address:

Legal Name:
Address:

Legal Name:
Address:

Legal Name:
Address:

Acknowledgment
I/We have read the above and agree that the best of my/our knowledge and belief same fully represents the true statement of facts. I/We acknowledge that coverage is losses from unlocked vehicles and overnight vehicle storage are excluded.
Date

MonthDayYear
Date
Signature
Should be Empty:

Production Details

Rented Equipment

Liability

Acknowledgment