Equipment Floater Application
Contact Information
  • Name of Insured                        
  • Entity Type                                 
  • Street Address                            
  • City                                            
  • State                                           Zip
  • Contact Person                          
  • Phone                                        
  • Fax                                          
  • Email                                          
Qualification Questions
Any equipment losses in the past 5 years? Yes No
Principally involved in pornography production? Yes No
Any coverage cancelled or denied in the past 3 years? Yes No
Are you primarily in the business of renting equipment to others? Yes No

Additional Information
Years of Industry Experience

Description of Business Operations

Address of primary location
(if different than mailing address above)

If scheduled equipment is over $100,000 advise name of central station alarm company at primary location:

Prior Coverage
Carrier Name Policy Number Expiration Date

Coverage Options

Effective Date of Coverage

Category
Scheduled Equipment Limit to Insure
  • Editing/Post Production Equipment
  • Recording/Studio Equipment
  • Sound/Location Recording Equipment
  • Musical Instruments/Band Equipment
  • Camera/Production Equipment
  • P.A./Sound Reinforcement Equipment
  • Office Contents
  • Theatrical Equipment

Unscheduled Equipment
Rented Equipment
Unscheduled Equipment ($10,000 maximum)
Rental Reimbursement (Daily Limit)
$500 $1,000
$1,500 $2,000
$2,500

Authorized Agent: Date