Special Event Insurance Application

SPECIAL EVENTS INSURANCE APPLICATION
Insurance Quotation Request

APPLICANT IS:
INDIVIDUAL CORPORATION PARTNERSHIP JOINT VENTURE OTHER (specify)

DATE

COMPANY NAME

E-MAIL ADDRESS

ADDRESS OF EVENT

City:                                   State:                              Zip Code:

DESCRIBE LOCATION OF EVENT:

TELEPHONE NUMBERS
Home:                                Work:


DATE OF EVENT:   From: To:
COVERAGE DATES REQUIRED (IF OTHER THAN EVENT DATES)

ESTIMATED ATTENDANCE PER DAY:     TOTAL ESTIMATED PARTICIPANTS:
GROSS RECEIPTS:     MAXIMUM CAPACITY OF LOCATION OF EVENT:

DETAILED DESCRIPTION OF EVENT:

EVENT WILL BE HELD:    INDOORS    OUTDOORS

SEATING WILL BE:    RESERVED    GENERAL ADMISSION

CROWD CONTROL:
PRIVATE SECURITY     ARMED    UNARMED    #
OFF-DUTY                    ARMED    UNARMED    #
POLICE
GUARD DOGS

home \ services \ contacts \ companies \ programs