Special Events

Special Events

One or multiple day events
Are you filling this out on behalf your client?
I am a(n)
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
What Type of Event?
Where is your event?
Total days of coverage you need
Daily Attendance
Combined no of People
Policy Preference
Alcohol Coverage
Coverage Limits
Damage to Rented Premises: Increase to $300,000
Need a Waiver of Subrogation?
Need Hired & Non-Owned Auto?
Dates of Coverage Start Date
Dates of Coverage End Date
I understand that the dates selected above are the only dates that will be covered by this policy. Each date is midnight to midnight. I have selected all set-up and clean-up days necessary for my event.
Are there water activities, amusement devices, inflatables, rides or animals?
Is there camping, sleeping overnight or events past 2 AM? (If going past 12 AM, be sure the following day is included in your date selections above.)
Will your event(s) be a political or activist event, protest, rally or march or could you or your organization's activities result in a political or activist protest, rally or march now or in the future?
Have you or anyone involved in the Event had more than 2 Event Liability Claims/Losses or any Event Liability Claim/Loss valued over $10,000 in the past 3 years?
Will you, the insured, your operations, your products, or your event participation have any involvement with cannabis or cannabis-related products?
Your Name & Address (Event Holder)
Your Name

First NameLast Name
Your Business Name (optional)
Insured's Address (Your Address)

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Your Email
example@example.com
Event Location / Additional Insured 1
Name of Certificate Holder - Location Name
Certificate Address

Street Address

Street Address Line 2

CityState

Zip Code
Contact Email (optional)
example@example.com
Signature
Should be Empty:

Special Events

Your Name & Address (Event Holder)

Event Location / Additional Insured 1