Special Event / Liquor Liability Quote Request

Page Insurance, Ltd

102 Boston Street

Guilford, CT 06437

(203) 453-5258

info@pageins.com
Having a special event soon? Complete the form below for a quote. We will get back to you as soon as possible.
Name of Applicant
Your Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail Address
Event Date

MonthDayYear
Type of Event
Address of Event

Street Address

Street Address Line 2

CityState

Zip Code
Your Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Do you need coverage for setup and take-down dates?

YesNo
Total # Attendees:
# Attendees Consuming Alcohol:
Who will cater your event?
Will the caterer serve alcohol?

YesNo
Any other activities?

YesNo
Describe any other activities.
Will the event last until after 2AM?

YesNo
Limit of Liability - BOTH General Liability and Liquor Liability are required

$1,000,000 Per Occurrence

$2,000,000 Agreegate
Submitted By
Agent
Agency Email Address
Should be Empty: