Event Insurance | S Valencia International

1Event & Liability Type and Liability limits

2General Liability

3Liquor Liability

4Concert / Musical / Theatre

5Parade

6Sporting / Athletic

7Motor vehicle show / Race

8Health Conventions

QUOTE REQUEST FOR SPECIAL EVENT INSURANCE

Please note, quotations take up to 48 business hours to complete. Also, coverage is not bound by this quote request. Thank you.

Type of Event A

Beer Garden/Tend

Concert/Musical/Theatre

Convention/Trade show/Exhibit

Competition or show

Type of Event B

Festival

Fundraiser

Individual Vendor Booth

Motor vehicle race/show

Type of Event C

Parade

Party/Social Event

Picnic

Health Fair / Convention

Type of Event D

Sporting / Athletic

Tournament

Wedding/Wedding Reception

Event - Other

You selected "other" please describe the event

Coverage Type and Limits

Coverage Type

Commercial General Liability ONLY

Liquor Liability ONLY

Commercial General Liability and Liquor Liability*

Limits of Coverage

What are the limits you are seeking?

We will evaluate your request and may have more questions,

Applicant Information

Applicant's Name(Required)

List only one legal and DBA name. Do not include "etal, " "Etc." or other similar wording in the name

Type of Event(Required)

Name of Event

Website

Applicant's Role in the event?(Required)

What role does the applicant play or what connection does the applicant have to this event?

Location Informaton

Address where the event will take place

Street Address Address Line 2 City State ZIP Code

Is the mailing address the same?

Yes

Mail Address

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email address of primary contact(Required)

Enter Email Confirm Email

Select form of Business

Form of Business

Please select

You selected "other" please explain

Number of Attendees(Required)

Will you be serving liquor or allowing others to serve liquor?(Required)

Yes

How many attendees do you anticipate will consume liquor?

Event Detail and Participants

1. Estimated Total attendees per day:

2. Estimated number attendees consuming Alcohol Daily

(if liquor liability coverage is desired)

Full schedule/description and purpose of event

(attach copy of brochure, website pages and flyer to this application or include details on all activities taking place) You are welcome to upload your brochure or email. Email to [email protected]

File - Upload up to 4 separate document if necessary

If you prefer to email the documents please email to [email protected] and be sure to include your business entity name.

Drop files here or

Accepted file types: pfd, jpg, jpeg, png, Max. file size: 20 MB, Max. files: 4.

Dates of Event

Note: If one day event, the end date should be the same as the start date. Quote will contemplate coverage for events continuing past 12 am.

From

What date will the event end?

MM slash DD slash YYYY

Starting date

MM slash DD slash YYYY

If event date(s) differs from desired coverage date(s) please explain

Is set-up and take-down coverage needed for additional dates?

Yes

Starting from what date?

MM slash DD slash YYYY

To this Date

MM slash DD slash YYYY

What will this exposure include?

Will there be any heavy machinery used such as bulldozers, backhoes, excavators, or any other types of industrial machinery (small forklifts and light machinery are acceptable)?

Yes

Would you like to include a rain date?

Yes

Which Date?

MM slash DD slash YYYY

Would you like to include coverage for banners?

Yes

Do / Does the Banner hang above a major roadway or trail behind an airplane?

Yes

Additional Interests, Insured, Certificates

Do you require any Additional Inureds?

Yes

Legal Name of Additional Insured

Describe the Additional Insureds interest

Name and Address of Additional Insured

Is there a landlord or property owner that required they be name on a Certificate of insurance?

Street Address City State ZIP Code

Special Endorsements

Would you like to include primary and non-contributory wording?

Yes

How manty contracts are needed for non-contributory wording?

Would you like to include waiver of subrogation?

Yes

How manty contracts are needed for waiver of subrogation?

History

Previous Insurance Carrier Name

Previous Policy Number

Insurance Claims

Commercial General Liability

If applicant is an individual exhibitor/vendor, what is the estimated number of attendees per day anticiapated to visit your booth?

Will there be entertainment?

Yes

Please describe entertainment provided

Mechanical Devices

Yes

Please list what types of mechanical devices

Will the event feature any Firearms?

Yes

Explain this event using firearms

Will this event feature any Fireworks?

Yes

Please describe what kind and any safety methods

Will the fireworks display be conducted by a third party who carries general liability limits os at least $1,000,000 per occurrance with a $2,000,000 aggregate?

Yes

Name and Address of Third party

Name of Firm Mailing address City State / Province / Region ZIP / Postal Code Country

Will fireworks vendor name you as Additional Insured on their insurance?

Yes

Will the fireworks be discharged at a minimum of 75 fee from the attendees?

Yes

Will there be overnight camping or bonfires?

Yes

Water Hazards

Are there any water hazards?

Yes

Will attendees be permitted to swim, boat, jet ski or fish?

Will there be haunted house, hayride or corn maze?

Yes

Please describe

Will there be any high profile attendees?

Yes

Please provide a list of name(s)

If security is provided by independent contractors, are they required to carry their own insurance?

N/A {Not applicable)

Yes

Describe Security Measures

Will you or your vendors be serving any liquor?

Yes

Liquor Liability

From What Time?

Hours

Minutes

AM/PM

To What Time?

Hours

Minutes

AM/PM

Do hours vary?

Yes

If hours vary describe

For this Event are you acting in the capacity of a hired caterer or bartender?

Yes

Are you in the business or is this business one that regularly sells, serves or furnishes alcohol?

Yes

Are you the sole vendor server of alchol at this event?

Yes

If there are multiple vendors, are all participating alchohol vendors/servers required to carry liquor liability limits for the event equal to or greater than what you are apply for?

Yes

Will alcohol be dispensed by a professional bartender or server who has taken a formal alcohol awareness training course?

Yes

Will you be selling alcohol?

Yes

Is BYOB (Bring Your Own Bottle) or self-service of alcohol permitted?

Yes

Event Types

Concert / Musical / Theatre

Is this a concert/musical event?

Yes

Performs are

Local

National

Will pyrotechnics be featured?

Yes

Any special effects?

Yes

Describe special effects

Provide name of performer and describe type of music

Parade Event

Is this a Parade Event?

Yes

Describe parade route from start to finish

Has the Parade Event been approved by local authorities and will route be secured by police?

Yes

Please explain why it has not been approved by authorities.

Sporting / Athletic Events

Is this an Athletic Event?

Yes

Please describe this athletic event

Are athletes Professional or Amature?

Professional

Amature

Please list Professional Athletes

Motor Vehicle Race

Is this an off road, trail run, mud run or obstacle event?

Yes

Is this a Motor Vehicle Race, Rodeo, Tractor Pull or Truck Show?

Yes

Is the Venue designed specifically for this type of activity?

Yes

Are barriers Permanent?

Yes

How High are the barriers?

Yes

What is the distance between the barriers and spectators?

Yes

Are spectators permitted in the pit or infield area?

Yes

Is this a rodeo, are the transfer areas between animal pens and the competition restricted from the general public?

Yes

Will the event feature audience participation (e.g. calf scrambles)?

Yes

Is this and off road, trail run, mud run or obstacle event?

Yes

Car and Motor Vehicle Show

If this a car show/moror vehicle show?

Yes

Do vehicles remain stationary throughout the show?

Yes

Will the event feature burnouts, drag races or flame throwing?

Yes

Health Fair / Convention

His this a Health Fair/Convention?

Yes

Will the Event feature any medical or health treatment?

Yes

Please acknowledge that you understand that coverage is NOT bound by submitting this Form.

I understand coverage is not bound

No I do not understand

Sorry we cannot bind you by submitting this form

Please understand that all submission take time and must meet the eligibility terms and condition to receive a quote.