Special Event Insurance Application

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

Short-term Special Event