Kelly-Roberts Insurance Services - Entertainment Insurance Quote

Insurance Type*

Applicant Information

Name Insured*

Entity Type* Individual LLC LLP Corporation Non-Profit

Primary Address (no PO Box) Address 1*
Address 2
City*
State*
Zip*

Contact Name*

Phone/Fax*

Email*

Underwriting Qualification Questions

Will the production include any Hard-Core or Soft-Core pornography?* Yes No

Will the production include any live gangster rap music?* Yes No

Any unprotected or open heights above 15 feet?* Yes No

Will any production activities take place outside of the U.S. and Canada?* Yes No

Confirm your understanding that if coverage is provided, only one production will be covered by the policy(s) issued.* Yes No

Any employees supplied to or from an employee leasing operation (i.e. PEO)* Yes No

Production Details

Production Name*

Production Type*

Production Cost*

# of Episodes (if applicable)

Start/End Dates*

Shooting Locations* (Cities & States)

Synopsis*

Stunts*

Yes No

General Liability*

Yes No

Automobile*

Yes No

Inland Marine

Rented Equipment?* (Camera, Lighting, Sound, etc.) Yes No

Total Value* (if yes)

Owned Equipment?* (Props, Sets, Wardrobe, etc.) Yes No

Total Value* (if yes)

Workers Compensation

Workers Comp?* Yes No

	# Full Time Cast/Crew	# Part Time Cast/Crew	Total Payroll
Production*
Clerical*
Sales*
Editing*
Photography*

Underwriting Qualification Questions

The event will take place in the United States?* Yes No

Confirm only one event can be covered per policy.* Yes No

Does the event include any of the following? Stunts, Pyrotechnics, Aircrafts, Hazardous Activities, Car Races, Precision Driving, Mechanical Amusement Devices, Film Production, Live Rap or Hip-Hop Performances* Yes No

Any bounce houses or inflatables?* (If yes, certificates of insurance are required) Yes No

Any private armed security?* (i.e. armed security that work exclusively for you under your employ) Yes No

Event Information

Event Type*

Event Name*

Event Description*

Cost/Budget*

Artist/Band* (if any)

Average Daily Spectators*

Average Daily Participants*

Names of Celebrities* (if any)

Concert Information (if event type is concert)

Type of Music*

Music Decade*

Artist(s) Name(s)*

Venue Details

Name of Venue*

Address*

City, State, Zip*

Event Takes Place Indoors or Outdoors? Indoor Outdoor

Coverages

Coverage Start Date* (12 month term)

General Liability

Waiver of Subrogation Include Exclude

Liquor Liability (Host and No Host) Exclude 1,000,000

Inland Marine

Rented Equipment (Equipment of Others) Yes No

Third Party Property Damage Yes No

Owned Equipment - Scheduled (Replacement Cost) Yes No

Owned Equipment - Unscheduled (Actual Cash Value) Yes No

Automobile

Hired & Non-Owned Auto Liability Exclude 1,000,000

Hired & Non-Owned Auto Physical Damage (per vehicle/aggregate limit) Exclude 125k/500k

Workers Compensation

Yes No

Spectators & Participants Medical

Yes No

Event Cancellation

Yes No

Underwriting Qualification Questions

Insured is principally involved in pornography production?* Yes No

Is applicant in the business of renting equipment to others?* Yes No

Security

Years of Industry Experience*

Alarm Type* (check all that apply) Smoke Fire Burglar

Alarm Monitoring Company*

Coverages

Coverage Start Date* (12 month term)

Inland Marine

	Limit	Deductible
Production* Editing/Post Production Equipment Recording/Studio Equipment Sound/Location Recording Equipment Musical Instruments/Band Equipment Camera/Production Equipment P.A./Sound Equipment Theatrical Equipment Props, Sets, Wardrope
Rented Equipment* Camera, Lighting, Sound, etc. Props, Sets, Wardrobe
Negative Film/Faulty Stock*
Extra Expense*
Office Contents*

Equipment Rented to Others?* Include Exclude

Worldwide Coverage Territory?* Include Exclude

Disclaimer: By submitting this form you are allowing our agency to quote the lines of business requested above. This may or may not include motor vehicle reports, clue reports, and other credit related information.

Kelly-Roberts Insurance Services, Inc. - Los Angeles, CA * Austin, TX Insurance Brokers

Our History

Entertainment Insurance Quote

Please fill out the form below to receive an entertainment insurance quote from Kelly-Roberts Insurance Services.

Applicant Information

Underwriting Qualification Questions

Production Details

Stunts*

General Liability*

Automobile*

Inland Marine

Workers Compensation

Underwriting Qualification Questions

Event Information

Concert Information (if event type is concert)

Venue Details

Coverages

General Liability

Inland Marine

Automobile

Workers Compensation

Spectators & Participants Medical

Event Cancellation

Underwriting Qualification Questions

Security

Coverages

Inland Marine

Kelly-Roberts Insurance Services, Inc. - Los Angeles, CA * Austin, TX Insurance Brokers

Client Login

Our History

Entertainment Insurance Quote

Please fill out the form below to receive an entertainment insurance quote from Kelly-Roberts Insurance Services.

Applicant Information

Underwriting Qualification Questions

Production Details

Stunts*

General Liability*

Automobile*

Inland Marine

Workers Compensation

Underwriting Qualification Questions

Event Information

Concert Information (if event type is concert)

Venue Details

Coverages

General Liability

Inland Marine

Automobile

Workers Compensation

Spectators & Participants Medical

Event Cancellation

Underwriting Qualification Questions

Security

Coverages

Inland Marine