• Special Event Insurance Application

  • Applicant is:

  • Event Location

  • Prior Insurance Information

  • 1. Has this event ever been held previously?
  • Rows
  • 2. Do you have any prior claims?
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  • GENERAL LIABILITY SECTION - Please answer all of the following questions:

  • 1. Per Occurrence/Aggregate Limits
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  • C. What is your involvement in the event? Check all that apply:
  • D. Is a Certificate of Insurance required from all exhibitors/vendors?
  • Db. If sponsoring this event, are you requesting to be named as additional insured on vendor's policy?
  • E. Are additional insureds needed?
  • H. Is there a grandstand or bleacher seating?
  • I. Is there a barrier between the exhibition and the spectators? (Barrier required for events with vehicles)
  • J. Are spectators allowed to participate in any of the sponsored events?
  • K. Are participants required to sign any releases of waivers? (If so, please attach a copy.)
  • L. Will you be using any mobile equipment? Check all that apply.
  • La. What is the use of this equipment? Check all that apply.
  • M. Will the applicant serve alcohol?
  • N. Will applicant allow others to serve alcohol at this event? (If so, certificates of insurance are required.)
  • Is Liquor Liability desired? (If YES, please answer all questions below. If NO, do not complete this section. )

  • LIQUOR LIABILITY SECTION
    Note: Liquor Liability is only available if we provide the General Liability coverage for this event:

  • A. Liquor Liability Limit. Per Occurrence/Aggregate Limits
  • Rows
  • E. Is a liquor license required for this event?
  • F. Will the servers of the alcoholic beverages be licensed bartenders?
  • G. Will there be law enforcement officers in the immediate area?
  • H. Will there be a double fence around the area where alcohol is served?
  • I. Will anyone under the age of 21 be permitted in the area where liquor is served?
  • Ia. If yes, will wristbands be used?
  • J. Will ID’s be checked?
  • K. Has applicant hosted similar events with the sale of alcohol?
  • Ka. If yes, has applicant ever been cited for violation of a law or ordinance relative to the sale of alcohol?
  • Kb. If yes, have there been any fights among patrons during previous events?
  • Kc. If yes, have there been any fights between employees and patrons?
  • L. Does the applicant currently have Liquor Liability coverage?
  • M. (NOT APPLICABLE IN MISSOURI) Has applicant ever had liquor liability coverage non-renewed or cancelled?

  • SIGNATURE

  • I have read the above questions and I hereby declare to the best of my knowledge and belief that all of the foregoing statements are true and that these statements are offered as an inducement to the company to issue the policy for which I am applying.

    NOTICE: PLEASE READ BEFORE SIGNING!
    In order to underwrite the insurance applied for above, an investigation consumer report may be requested and made, including information as to the character of the applicant for insurance and the persons to be insured under the policy applied for, their general reputations, business characteristics and credit standing. You are advised that you may make a request within a reasonable time after receipt of this Notice for a disclosure by Insurance Company of the nature and scope of the investigation requested.
    Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

  • Questions? 877-244-9090
    Kevin Morency |  kmorency@morencyinsurance.com 

    Morency & Associates Inc.
    141 New Shackle Island Rd, Hendersonville, TN 37075
    Fax: 615-452-6580

    https://specialtybusinessinsurance.com/

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