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  Liquor Liability

Special Event Insurance Quotation

Welcome to our Special Event Insurance Quotation quotation page.

For a free quote, fill out the secure form below and click submit. Please fill in as much of the information as possible to assist us in getting to you the most accurate quote. All information is held in the strictest confidence.

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Insured's Information

Your Name Business Name DBA

Is the applicant:

[ select one ] Corporation Partnership LLC Joint Venture Sole Proprietor other if other, please describe:

Mailing Street Address Mailing Street Address (continued) Mailing City Mailing State Mailing Zip Code Contact Person Home Phone Mobile Phone Email Website Address Name of Event Description of Event Policy Period Requested

Limits of Liability Coverage Requested

[ select one ] $1,000,000 $2,000,000 other if other, enter amount:

Estimated Number of Events Dates of Events Opening and Closing Hours of Event Location of Event Site(Name of Facility and Address) Premises/Occupation Acres What is your past experience producing this type of event? Gross Receipts Last Year This Year's Budget Estimated Total Attendance This Year Total Attendance Last Year List Any Additional Insureds Previous Carrier

Any cancellations, declinations or non-renewals?

yes no if yes, please describe:

Does this Organization engage in any other business operations under the same name?

yes no

Will any of the following additional coverage be needed? Liquor Liability, Fireworks Liability, Excess Fireworks Liability, Off-Premise Parade Liability, Excess/Umbrella Liability, Cancellation Insurance, Weather Insurance?

yes no if yes, please list:

Who provides security for this event? [ select one ] City County State Employees Private Agency none other Does the private agency provide a Certificate of Insurance? [ select one ] Yes No N/A If officers are the event employees, are they armed? [ select one ] Yes No N/A Average number of security officers per event day Type of medical personnel at event [ select one ] Paramedic EMT/EMS Nurse Other Number of Medical Personnel Distance to Nearest Hospital Response Time in Minutes

Is there an ambulance on site?

yes no

Describe any other medical facilities on site Emergency Evaculation Plan - How is event management notified and how is the crowd notified? Type of Concert, if applicable [ select one ] Hard Rock Jazz Country Western Classical Bluegrass Pop Rock other

Do professional performers hold event management harmless with regard to their injuries?

yes no

Type of Seating During Event [ select one ] Assigned Festival None If event is held indoors, does security check for cans and bottles at door? [ select one ] Yes No N/A Number of Grandstands and Year Built Grandstand Construction Type [ select one ] Wood Metal Concrete Grandstand Height (ft) Grandstand Guardrail Type [ select one ] Sides Back Kickboards in place Number of Bleachers and Year Built Number of Bleachers Fixed Bleacher Construction Type [ select one ] Wood Metal Concrete Bleacher Height (ft) Number of Portable Bleachers Bleacher Guardrail Type [ select one ] Sides Back N/A

Kickboards in place?

yes no

Do you have documented inspection/maintenance program for grandstands and/or bleachers?

yes no

If so, date of last inspection If event is held outdoors, describe fencing used to prohibit entry by non-ticket holders

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We will need the following information to completely process this application:

• Copies of all insurance certificates from vendors that list you as Additional Insured
• All contracts/lease agreements/hold harmless agreements relating to this event in which event management has agreed to assume the liability of another party
• Diagram/Site plan of location/setup
• Complete schedule of events (i.e. marketing brochure identifying all planned events/activities)
• Most current financial statement
• Four (4) years detailed loss history from previous carrier(s)
• Copy of previous insurance policy

How Did You Hear About Us? [ select one ]Internet Friend/Colleague Mailer Other

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Northern California

Toll free: 800-722-6606

1045 N. Fourth Street
San Jose, CA 95112
Tel: 408-298-9882
Fax: 408-298-9886

P.O. Box 837
Bodega Bay, CA 94923

Southern California

Toll free: 800-722-6606

P.O. Box 99593
San Diego, CA 92169

Toll free: 800-722-6606