Special Events Application

Submit this information if you are planning a concert or special event.
We will contact you with a free, no obligation quote, usually within 48-72 hours.
Contact Information
  • Name of Company / Organization
  • Entity Type                                 
  • Street Address                            
  • City                                            
  • State & Zip                                 
  • Contact Person                          
  • Phone                                        
  • Fax                                          
  • Email                                           
Qualification Questions
  • Any: Stunts, Pytotechnics, Aircrafts, Hazardous Activities, Car
    Races, Precision Driving, Mechanical Devices, Film Production,
    Rap/Tip-Hop, Rock/Metal, Rides, Water Activities?                 Yes                     No
  • The event will take place in the United States?                      Yes                     No
  • Any armed private security guards?                                      Yes                     No
  • Any prior production with any losses of any kind?                    Yes                     No
  • Any bounce inflatables?                     Yes                     No
Event Details
  • Type of Event
  • Event Name
  • Budget (Cost of Event)
  • Brief Description of Event
  • Venue Name, Address, City, State, Zip
  • Location Information                                         Indoors                    Outdoors
  • List Celebrities (if any) at Event


For Concerts Only
  • Type of Music
  • Music Decade
  • Artist Name(s)
Coverage Options
          Attendance
  • Average Daily Spectators

  • Average Daily Participants

General Liability
  • Blanket Additional Insured/Certificates of Insurance                     Automatically Included
    (Except City Certificates)
  • Aggregate/Occurrence Limit
    $1,000,000 / $1,000,000                $2,000,000 / $2,000,000                     $3,000,000 / $3,000,000
    $4,000,000 / $4,000,000                $5,000,000 / $5,000,000
  • Waiver of Subrogation                                                   Include                 Exclude
Additional Coverages
  • Rented Equipment Limit ($100,000 maximum)                        

  • Third Party Property Damage                             None                         $25,000.
                                                                          $50,000.                  $100,000.
  • Liquor Liability ($1,000,000 limit)                                               Include                       Exclude
  • Event Cancellation                                                                   Include                       Exclude
  • Participants Medical                                                                 Include                       Exclude
  • Spectators Medical                                                                  Include                       Exclude
  • Hired & Non-Owned Auto Liability ($1,000,000 limit)                    Include                       Exclude
Vendors Coverage
(Only if you want your coverage to extend to the vendors)
  • Number of                     Exhibitors (no sales)                    
                                        Concessionaires (non-food sales)  
                                        Concessionaires (food sales)       
                                        Performers & Attractions             

Coverage Dates of the Event

Applicant                                                                                                        Date