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GENERAL LIABILITY INSURANCE APPLICATION
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POLICY HOLDER INFORMATION
Applicant/Company Name
Address
Zip Code
City
State
Is the Applicant either a US based entity or Individual who is a US resident, citizen, or has an ACTIVE student or work VISA? (Visa must be active throughout the insurance policy period)
Yes
No
CONTACT INFORMATION
First Name
Last Name
Email
Alternate Email
Phone
Alternate Phone
Fax Number
PRIOR INSURANCE INFORMATION
Have you had any prior Entertainment/ Production Insurance for your company?
Yes
No
Please describe (Who were you insured with, and when?)
Have you had any liability claims or losses in the last 5 years?
Yes
No
Please describe
Will any production activities take place outside of the U.S.?
Yes
No
Please list the countries
What is the total number of years of experience?
Will you be using any drones, unmanned aerial vehicles or remote controlled aerial devices in this project?
(If you already have separate Drone/Aviation Liability that covers these exposures, please mark "No")
Yes
No
Please describe
Will there be any unprotected or open heights above 15 feet?
Yes
No
Please describe
Please provide detailed description of Business Operations:
Will you have any scenes with partial or full nudity?
Yes
No
Please describe
GENERAL LIABILITY
Will you need a quote for General Liability Coverage? (Are you being asked to provide a certificate naming a rental house or location as an “Additional insured?”)
What is the difference between General liability coverage and equipment coverage? Please click
here.
Yes
No
I need General Liability Insurance for the following purposes:
(Please select All that Apply)
To Rent and/or borrow equipment (from a rental house or an equipment owner)
To Rent film locations
To Obtain city permits
To Satisfy insurance requirements for sponsors or payroll organizations
To Rent vehicles (This is covered by Auto Liability)
Have you had any liability claims in the last 3 years?
Yes
No
Please describes all claims with claim amounts
Would you like an annual or short-term general liability insurance?
Annual
Short Term
What day would you need the liability coverage to start?
Effective Start Time?
What day would you need the liability coverage to end?
Annual or Short-Term endorsement?
Annual
Short Term
What day would you need the liability coverage to start?
What day would you need the liability coverage to end?
Date-Only Endorsement
What limit of coverage do you need?
$1M per occurrence/ $1M aggregate
$1M per occurrence/ $2M aggregate
$1M per occurrence/ $3M aggregate
$1M per occurrence/ $4M aggregate
$1M per occurrence/ $5M aggregate
Do you want to add $5,000 of medical expense coverage to cover third-parties for an additional premium?
Yes
No
Will the rented equipment be used or involved with any hazardous activities such as stunts, animals, fire, pyros, aircraft, drones, helicopters, rigging, scenes involving motorized vehicles, watercraft, guns, blanks, squibs, fight scenes, filming outside the United States, stage rentals, filming above and/or under water, sports activities, live hip hop, live electronic dance music performances or other special activities?
Yes
No
Please describe
Are any of your contracts requiring you to add a
Waiver of Subrogation
?
We recommend reviewing any insurance requirements in your location/vendor contracts. If you're not sure, please mark "No." This can be added after purchase (as long as policy is still active).
Yes
No
Enter the Entit(ies) requesting a Waiver of Subrogation endorsement (Each entity costs $100 to add):
Name
Address
Relation to the applicant
Are any of your contracts requiring you to have
Primary and Non-Contributory
coverage?
We recommend reviewing any insurance requirements in your location/vendor contracts. If you're not sure, please mark "No." This can be added after purchase (as long as policy is still active).
Yes
No
Enter the Entit(ies) requesting a Primary and Non-Contributory endorsement (Each entity costs $100 to add):
Name
Address
Relation to the applicant
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General Liability
When renting equipment from other people and/or rental houses:
Equipment coverage insures theft and accidental damages of equipment you rent or borrow from others.
General Liability insurance covers third party bodily injury lawsuits, if a third party (a spectator, a non-cast, and/or non-crew member of your project) is injured by the rented equipment and sues you and/or the rental house or equipment owner for the injury.
Please note that injuries to employees, cast and/or crew members would only be covered by a separate Workers Compensation policy, not a general liability policy.
General liability Terms and Conditions
Please check all terms and conditions:
I confirm and understand that I am requesting a quote for general liability insurance for the sole purpose to rent equipment and the liability associated with the equipment only.
I acknowledge I’m applying for liability only to rent equipment, and
NOT
to cover any other activity or liability associated with producing films, productions or events including obtaining locations/permits.
I understand the following limitation will be listed on this liability policy: Coverage is limited to cover the maintenance, operation or use of equipment leased to you by a third party for the purpose of production related activities.
OR
If you cannot agree to any or all of the above terms, please check this box.
Please describe what terms you cannot meet and why.
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