Please provide the following information: Name of Production Company Address Phone Mobile Phone FAX Email Website The Applicant is: An Individual A Partnership A Corporation (If the Applicant is a Corporation, please provide the following names) President Vice-Pres Secretary Treasurer Experience of Applicant (examples): Years in this business Previous Insurer Has the Applicant ever had any similar insurance declined or canceled in the past five (5) years? Yes No (If yes, explain) Has the Applicant had any previous losses over $10,000 (insured or uninsured) sustained by the Producer in the past five (5) years? Yes No (If yes, explain) Premium Audit Contact: Name: Phone: Productions are on: Film    Percent Film  Tape   Percent Tape Both Production personnel are: Union Members Non-Union Members Estimated number of Productions to be produced annually: Estimated gross annual production costs: Film:  $ Tape: $ Total: $ Post-production Is any post-production work done for others? Yes No Estimated annual receipts $ (Please send a copy of contract) Types of films to be produced: Commercials Documentaries Educational Films Training Films Music Videos Animated Films Other (Please Describe) Maximum cost any one production: $ Maximum loss exposure in dollars any one occurrence $ (Total amount of negative film without protection prints at any one time stored at one location) Maximum exposure timespan Maximum length of time any one production from start of photography to date of protection print: (If over 90 days, please explain) Average exposure timespan Average estimated length of time from start of photography to date of protection print of all productions to be insured. Production Locations Are projects scheduled or anticipated to be produced outside of the United States, the Provinces of Canada, Western Europe, Australia, and New Zealand? Yes No If Yes, please explain: Coverage Desired Negative/Videotape Do you want coverage for Negative / Videotape? Yes No (If yes, fill out below) Name and Location of principal: Laboratories to be used: Vaults to be used: Cutting rooms to be used: Average distances of shooting locations to laboratory: Any special film processes, special effects or equipment (e.g. Panavision, Cinerama, Imax, etc.) Yes No Limit of Coverage $ Faulty Stock, Camera, and Processing Do you want coverage for Faulty Stock, Camera, and Processing? Yes No (If yes, fill out below) Procedures: Explain procedures the Applicant follows in testing cameras, lenses, raw stock and equipment to prove them to be sound prior to commencement of filming or taping: Limit of Coverage $ Deductible $ Props, Sets, and Wardrobe Do you want coverage for Props, Sets, and Wardrobe? Yes No (If yes, fill out below) Full 100% Value of Owned $ (Please send schedule) Rented: $ (maximum value at any one time) Limit of Coverage $ (owned and rented combined) Deductible $ (owned and rented combined) Miscellaneous Equipment You must have coverage for Miscellaneous Equipment... (Please fill out below) Full 100% Value of Owned $ (Please send schedule) Rented: $ (maximum value at any one time) Miscellaneous Equipment Description: Brief description of protection of property on the insured's premises; (fire fighting equipment, watchman, alarm etc.) Return Location: Location to which Miscellaneous Equipment and Props, Sets and Wardrobe will be returned: Limit of Coverage Owned $ Rented $ Deductible Owned $ Rented $ Third Party Property Damage You must have coverage for Third Party Property Damage... (Please fill out below) Third Party Property Description: Brief description of property (other than miscellaneous equipment, props, set, etc.) or facilities to be used in connection with the production for which the Applicant may be responsible: Limit of Coverage $ Deductible $ Extra Expense You must have coverage for Extra Expense... (as a result of loss of or damage to property or facilities used in connection with the Insured production(s)) (Please fill out below) Extra Expense Description: Estimated time needed to reconstruct destroyed sets or scenery: Estimated time needed to replace lost or destroyed equipment: What other location or studio facilities would be immediately available? Limit of Coverage $ Deductible $ Business Personal Property You must have coverage for Business Personal Property... (Please fill out below) Full Address of Premises/Location(s): Full 100% Value of Owned $ (Please send schedule) Rented: $ (maximum value at any one time) Limit of Coverage $ (owned and rented combined) Deductible $ (owned and rented combined) Other Coverage Do you want Other Coverage? Yes No (If yes, fill out below) Please Describe: Limit of Coverage $ Deductible $     Motion Picture Production Application (Film & TV) Producer's Package Application (DICE) Short-term Productions Short-term Special Event Errors & Omissions Liability (Radio, TV, Film Producers)

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