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Your Name:*
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Title:
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Your Organization
or Business Name:
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Company Address (Physical Address please, No PO Box Allowed):
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Street:
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City:
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State:
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Zip:
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Phone#:*
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Cell Phone#:
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Fax#:
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Org. E-mail:
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Organization
Web Address:
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Do you need a Short Term or Annual Policy:
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Is this for a single event lasting longer than 3 weeks?
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Are you an Event Organizer/Planner or an Exhibitor/Vendor?
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Event Detail:
Please describe your
event of service:
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Event Name:
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Event Website:
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Venue Name:
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Venue Address:
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Event Start
Date:
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Event End
Date:
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Coverage Start Date:
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Coverage End
Date:
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If the coverage start date is more than 5 days before the event start date
or the
coverage end date is more than 5 days after the event end date, please explain
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Is the Event Outdoors?
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How many years has this event been held under the present management?
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During this time has the insured had any claims regarding this event?
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Type of Event?
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Maximum Daily
Attendance #
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Total Attendance #
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Average Attendance #
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Gross Revenue $
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Number of Events per
year for annual policies?
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Expenses $
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Required Limits of Liability
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Will your event include any of the following?
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The Serving of Beer, Wine or Alcoholic Beverages?
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Renting or using someone else's vehicle to get to and from the event or
to
deliver goods and equipment to the event?
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Did the Venue request a Certificate or Proof of Insurance from you?
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If yes, did they ask to be named as Additional Insured on your event policy?
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Did the Venue in a written contract require a "Waiver of Subrogation" Clause
on the Certificate of Insurance?
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Are you renting equipment for your event?
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If yes who is insuring it while it is in your case, custody and control? Please
explain
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Will any of the events include any of the following?
Please check all that apply whether you, the venue, or a Subcontractor
(A Subcontractor is a 3rd Party who is part of the event but not necessarily hired
directly by you.)
Please check off who is providing the insurance.
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