Foreign Production Application

Foreign Production Application
Click here for Insurance Terms & Definitions.
APPLICANT INFORMATION
How did you hear about us?*
Select how you found our website.
What coverages do you require?*

General Liability (Required)Inland Marine (Rented Equipment & Property Coverage)Contingent Auto CoverageEmployers Responsibility
Insured Name*
The name of your production company or entity (or individual name if not incorporated) you would like to insure. Use the same name as on your rental quote.
Entity Type*
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*

Confirmation Email
Website
Description of your operations:*

Any insurance declined or canceled in the past 3 years (not applicable in MO)?*

YesNo
If yes, please explain:*
Any losses in the past 3 years?*

YesNo

Rows	Policy Type	Carrier	Policy #	Expiration Date	Premium Paid
Policy

Rows	Policy Type	Date of loss	Description of loss	Amount of loss
Claim

PRODUCTION DETAILS
Project Title*
Project Synopsis*
2-3 sentences describing your film's story.
Are you using any non-firing prop guns? It may not be considered as hazardous activity but underwriters require disclosure.*

YesNo
Type of Production*
Artist Name*
Genre of Music*
Brief description of the music video:*
How many episodes?*
Length of each Episode?*
Total Gross Production Budget*
Estimated costs, including overhead, chargeable directly to the production stated at the time of declaration of an insured production or series of productions. The following costs are not included: story, scenario, music rights, sound rights, royalties, residuals, continuity, premiums paid for the insurance, interest on loans and taxes.

Filming Locations: (One Per Country)*

Coverage Start Date*

MonthDayYear
Date
Coverage End Date*

MonthDayYear
Insurance exp. is 12:01am. If your last day or filming is April 25th use April 26th as the last day of coverage (as it will expire on 04.26 12:01am).
Are you Renting Equipment?*

YesNo
Name and Address of Rental House:*
Equipment Pickup Date*

MonthDayYear
Date
Equipment Drop Off Date*

MonthDayYear
Date
Production Personel
Producer’s or EP’s name:*
Contact phone number:*
Email*
example@example.com

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 Limit*
Film permit offices, locations typically require the $1M liability limit.
General Liability Enhancements
Special Certificates:

IncludeExclude
Waiver of Subrogation

IncludeExclude

INLAND MARINE

Property Coverage such as rented camera equipment etc.
Unscheduled Owned Equipment ($250,000 maximum):
(total replacement cost value)
Rented Equipment, Props, Sets and Wardrobe ($250,000 maximum)
Enter a dollar ammount.

CONTINGENT AUTO LIABILITY

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*

IncludeExclude
Hired & Non-Owned Auto Physical Damage*

Exclude$25,000 / $25,000Other

Additional Information, Comments
Additional Information or Comments, if necessary, can be provided.
Would you like to receive a complimentary Errors and Omissions quote for your completed film?

YesNo
Would you like to receive our quarterly newsletter?*

YesNo
NY License # BR-1001302

CA License # 0I36156 - dba in CA as New York Film Emporium Insurance Services
Should be Empty:

UNDERWRITING QUALIFICATION