Please provide the following information: Name Title Company Address Work Phone Mobile Phone FAX Email Website Name of Event Please send copy of brochure, ad, or flyer. Description of Event Does event include? Watercraft, aircraft, motorbikes, snowmobiles, stunts, animals, pyrotechnics, chase scenes, guns, car races, mechanical devices, rap/hiphop/rock/metal, water activities, etc. Yes No Event Dates Event Times Name of Event Site or Facility Address of Facility Indoor Outdoor Both Cost/Budget of Event $ Please send copy of rental agreement. Any Celebrities at event? If yes, please enter names Contact Person at Site Address Phone FAX Site Capacity Estimated Daily Attendance Estimated Daily Attendance Admission Charge $ # of Vendors or Exhibitors Type of Seating Reserved General Admission Other Security Information Name of Security Type of Security Any armed private Security Guards? Yes No Liquor Liability Do you need liquor liability Insurance? Yes No Estimated liquor sales $ Prior History Previous insurance Company (if any) Prior Claims (if any) $ Please answer the following for sporting events only. Maximum # of participants Number of Spectators Do you want participants insured? Yes No Number of participants in previous year     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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