Event Insurance Request
Business Name
*
Type of entity
*
Please Select
Sole Proprietorship
LLC
S-CORP
C-CORP
Partnership
Trust
Non-Profit
Your Name
*
First Name
Last Name
Mailing address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Your Phone Number
*
Format: (000) 000-0000.
Event Name
*
Type of Event
*
Please Select
Art & Music
Athletics (e.g. walks, runs, etc.)
Boar Rentals
Cultural
Demonstration
Formal
Fundraising
Group Business
Learning
Membership Intake Rush
Membership Intake DPR/NIP
Parade
Party
Philanthropy
Service
Social
Spirituality
Voter Registration
Street Fair
Other
Event setup date
-
Month
-
Day
Year
Date
Event Date
*
-
Month
-
Day
Year
Date
Event Take Down
-
Month
-
Day
Year
Date
Event Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Event End Time
*
Hour Minutes
AM
PM
AM/PM Option
Name of Venue
*
Venue Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Venue Contact Email
*
example@example.com
Is this event co-sponsored?
*
Yes
No
Co-sponsoring Organization
*
Will there be alcohol at the event?
*
Yes
No
Number of Attendees
*
Total cost of event
*
Event is held
*
outdoor
indoor
Event Description
*
Is an additional Insured Certificate required for the event?
*
Yes
No
Insurance requirements
*
Legal Entity Name for Organization (Insured Certificate)
*
Just put N/A if a certificate is not required
Mailing Address to Appear on Certificate
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you have multiple additional insureds, please add them here:
Submit Form
Should be Empty: