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Contact Information
Name of Company / Organization *   Entity Type *  
Address *   City *  
State *   Zip Code *  
Contact Name *   Phone *  
Email *   Fax  
Qualification Questions
Any: Stunts, Pyrotechnics, Aircrafts, Hazardous Activities, Car Races, Precision Driving, Mechanical Devices, Film roduction, Rap/Hip-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 Event With Any Losses of Any Kind? Yes No
Event Details
Type of Event   Event Name  
Venue Name   Budget (Cost of Event)  
Venue Address   Venue City  
Venue State   Venue Zip Code  
Location Information  
List Type of Attractions / Equipment
Brief Description of Event
For Concerts Only
Type of Music   Music Decade  
Artist Name      
Coverage Options
  Average Daily Spectators
  Average Daily Participants
General Liability
  Waiver of Subrogation Include Exclude
Additional Coverages
  Rented Equipment Limit ($100,000 maximum)
  Third Party Property Damage Include Exclude
  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
Vendor's Coverage
(only if you want coverage to extend to the vendors)
  Number of Exhibitors (no sales)
  Number of Concessionaires (non-food sales)
  Number of Concessionaires (food sales)
  Number of Performers & Attractions
Coverage Dates of the Event

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