Entertainment Equipment Floater Application

Entertainment Equipment Floater Application

This application is for those who want to insure equipment they own. Please fill out the following form in order to receive a quote for insurance.
Click here for Insurance Terms & Definitions.
APPLICANT INFORMATION
How did you hear about us?*
Select how you found our website.
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:*

UNDERWRITING QUALIFICATION

Please answer the following questions to determine if the production qualifies for short term production insurance.
Are you in the business of renting equipment to others?*

YesNo
Years of industry experience:*
Protection Details
Protection/Security Device at primary location:*

NoneAlarm SystemDead BoltsBars on WindowsSecurity GuardsDogs On Premises
Alarm Company Name*

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

RENTED EQUIPMENT

Indicate total replacement value for each desired coverage.
Camera, Lightning, Sound, etc:
Props, Sets & Wardrobes:
Rented Furs, Jewelry, Arts & Antiques:
The Props, Sets & Wardrobe form provides up to $25,000 for furs, jewelry, arts, antique coverage. If a higher limit is required, include the additional limit under this coverage. A schedule/appraisal of the item(s) will be required.
Additional Coverages
Faulty Stock:
Library Stock Coverage:
Expands the definition of negative film, videotape and digitalized image to include insured's original cut negative film of completed or released productions, duplicate negatives, completed video tapes or other related media.
Extra Expense:
Third Party Property Damage:
Office Contents:
Business Income/Extra Expense:
Rental Cost Reimbursement:
Covers the potential additional expense to rent similar equipment after a loss.
EDP (Electronic Data Processing Equipment):
Computers and related equipment, media, software. Software extra expense is automatically included up to 25% of the hardware limit.
Limited Computer Virus:
Attaches to EDP and provides limited coverage for computer viruses.
Accounts Receivable:
Valuable Papers and Records:
Money & Securities:
Waiver of Subrogation:

IncludeExclude
Coverage Extension Endorsement:

IncludeExclude
Entertainment Enhancement Endorsement:

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