Short Term Production Application

Movie Boat Application
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
Will the production include any Stunts, Water-skiing or over-the-side activities?
If yes, please describe.
Will the production take place outside the US or Canada?
If yes, please explain:

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.
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 State)

Coverage Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Coverage End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearInsurance 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).
Production Personel
Producer’s or EP’s name:
Contact phone number:
Email
example@example.com

HULL & MARINE LIABILITIES
Pollution
Wharfinger's Liability
Excess General Liability Limit
Select only if higher limits are required. Film permit offices, locations typically require the standard $1M liability limit.

Vessel Details

Owner Details

Rows	Vessel #1	Vessel #2	Vessel #3
Owner Name
Address

Vessel Use

Rows	Vessel #1	Vessel #2	Vessel #3
Days in Operating Use (Not Docked)
Days in Operating Use (Docked)
How will the vessel be used in the production?

Insured Operation

Rows	Vessel #1	Vessel #2	Vessel #3
Is the insured operating the vessel?
Will the vessel be used out of water?

Attachment

Rows	Vessel #1	Vessel #2	Vessel #3
Place of Attachment
Navigation Area to be used:

Will the vessel be used within 50 miles of the attachment?

Rows	Vessel #1	Vessel #2	Vessel #3
Will the vessel be used within 50 miles of the attachment?

Vessel Specific Coverage

Rows	Vessel #1	Vessel #2	Vessel #3
Hull & Machinery

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?
Would you like to receive our quarterly newsletter?
NY License # BR-1001302

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