DICE / Annual Production Application

  • DICE / Annual Productions Application

    Please fill out the following form in order to receive a quote for insurance.

  • Click here for Insurance Terms & Definitions.

  • APPLICANT INFORMATION

     

  • What coverages do you require?*
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  • UNDERWRITING QUALIFICATION

    Please answer the following questions to determine if the production qualifies for production insurance.
  • Does your production have any of the following hazardous activities?*

  • Stunts, Falls, Fight Scenes, Pyrotechnics, Fireworks, Airplanes, Helicopters, Drones, Hang Gliders, Hot Air Balloons, Parachutes, Boats, Water Scenes, Animals, ATVs, Go Carts, Mopeds, Motorcycles, Scooters, Segways, Snowmobiles, Weapons, Firing & Non-Firing Prop Guns, Blanks, Squibs, UAV (Drones), Animals, Hard-core or Soft-core Porn, Precision Driving, or Chase Scenes or similar activites?

  • Are you using any non-firing prop guns?  It may not be considered as hazardous activity but underwriters require disclosure.*
  • Will the production take place outside the US or Canada?*
  • Are there any unprotected or open heights above 15 feet?*
  • Are there any employees supplied to or from an employee leasing operation (i.e. PEO)?*
  • Do you enter into any co-production agreements?*
  • Will you be flying any Drones/UAVs?*

  • Insurance History

  • Have you had any prior insurance coverage?*
  • Rows
  • Any insurance declined or canceled in the past 3 years (not applicable in MO)?*
  • Any losses in the past 3 years?*
  • Rows

  • PRODUCTION DETAILS

  • Coverage Start Date*
     - -
  • Rows
  • Any post-production operations?*
  • Any rental operations (to others)?*

  • UPCOMING PRODUCTIONS

    Please indicate the number of productions you anticipate in each category over the upcoming 12 months:

  • GENERAL LIABILITY

    General Liability covers payments the insured will become legally obligated to pay as a result of Bodily Injury or Property Damage arising out of an occurrence during filming your scheduled activities. Applies to third parties, excluding your own cast and crew, location. Injury to your own cast and crew can be covered under workers compensation, if selected. If you would like a quote with workers compensation a separate application is be required.

  • General Liability Enhancements

  • Blanket Additional Insureds/Certificates of Insurance:*
  • City / Other Special Certificates:
  • Waiver of Subrogation
  • Employee Benefits Liability*
  • Abuse & Molestation*

  • INLAND MARINE

    Property Coverage such as rented camera equipment etc.
  • Faulty Stock Broad Form
  • Library Stock Coverage
  • Extra Expense Coverage
  • Waiver of Subrogation*
  • Coverage Extension Endorsement*
  • Cinema Production Enhancement Endorsement*
  • Worldwide Coverage*

  • AUTO

    Vehicles rented for the production. Legal liability coverage for bodily injury or property damage claims arising out of the filming of the picture. Coverage may include the use of rented & non-owned vehicles, including physical damage to the vehicles. Hired/Non-owned auto coverage may be required on city or state roadways. Coverage does not apply to aircraft or watercraft, which must be separately insured. Physical damage to "hired vehicles" must be selected of you wish to insure against damages to the vehicle. Auto Liability coverage applies if you cause damage to vehicles other than your own.
  • Hired & Non-Owned Auto Liability (Rented)*
  • Waiver of Subrogation*
  • Will any bus or van be hired for the purpose of transporting people?
  • Hired & Non-Owned Auto Physical Damage (Rented)

  • CAST COVERAGE

    This coverage is different from Workers Compensation. It is additional coverage for certain KEY cast and crew members.
  • Cast Extra Expense*
  • Covered Persons Extension (without sickness)
  • Covered Persons Extension (with sickness)
  • Family Bereavement

  • WORKER’S COMPENSATION

    Covers medical injury to your hired cast or crew. This may include W2 employees, 1099 freelancers & volunteers. Available in most states.
  • Worker’s Comp limit of $1,000,000*
  • Waiver of Subrogation
  • Rows

  • Additional Information, Comments

  • Are you planning on getting a Film LA permit?*
  • Would you like to receive information on Errors and Omissions (E&O) coverage? E&O insurance will be required prior to release.*
  • Would you like to receive our quarterly newsletter?*
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  • NY License # BR-1001302          

    CA License   # 0I36156 - dba in CA as New York Film Emporium Insurance Services

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