Smith & Eddy Insurance_01-1016-00_Special Event Insurance

Special Event Insurance Request

Smith & Eddy Insurance
Name:

First NameLast Name
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Type Applicant is (please select one):question

IndividualPartnershipCorporationNon-Profit Organization
Type of Event:
Date of Event:

MonthDayYear
Date
Number of Attendees:
Alcohol (please select one):

Host Liquor CoverageNo Alcohol at The EventRetail Liquor Coverage
General Liability Limits (please select one):

$1,000,000 Per Occurrence $2,000,000 General Aggregate$1,000,000 Per Occurrence $3,000,000 General Aggregate$2,000,000 Per Occurrence $2,000,000 General Aggregate$3,000,000 Per Occurrence $3,000,000 General Aggregate
Liquor Liability Limits:

$1,000,000 per occurrence $2,000,000 General Aggregate
Please note: Any water activity, including Pool or Lake, will be Excluded from any Special Event Policy.
Please verify that you are human*
Should be Empty:

Special Event Insurance Request