What is the total number of years of production experience (the owner of the company)?

(This is to insure rented or borrowed vehicles used for production purposes.)
SELECT YES OR NO
COVERAGE
NON-OWNED & HIRED AUTO LIABILITY
SELECT YES OR NO
COVERAGE
NON-OWNED & HIRED AUTO PHYSICAL DAMAGE

NOTE: IF YOUR PRODUCTION INVOLVES ANY HAZARDOUS ACTIVITIES OR STUNTS, WE CANNOT QUOTE WORKERS COMPENSATION

SELECT YES OR NO
COVERAGE
WAIVER OF SUBROGATION
SELECT YES OR NO
COVERAGE
WORKERS COMPENSATION

NAME OF OWNERS MUST BE LISTED (The below individual(s) will be excluded from Workers Compensation coverage)

Select Limits
SELECT YES OR NO
COVERAGE
SELECT LIMITS
GENERAL LIABILITY
3RD PARTY PROPERTY COVERAGE (DAMAGE TO PROPERTY AT RENTED LOCATION I.E FLOORS, WALLS)
CITY / SPECIAL CERTIFICATES (I.E. FILM PERMIT OFFICE)
WAIVER OF SUBROGATION
PRIMARY AND NON-CONTRIBUTORY WORDING
Do music video productions make up more than 50% of your total productions?
SELECT YES OR NO
COVERAGE
EXCESS LIMIT
SELECT LIMITS





  1. YEAR YOUR BUILDING WAS UPDATED FOR

(What does this mean? Watch the video here.)
SELECT YES OR NO
COVERAGE
DO YOU NEED TO INSURE ANY RENTED OR BORROWED PROPS, SETS OR WARDROBES?
SELECT LIMITS
  1. (What does this mean? Watch the video here.)
SELECT YES OR NO
COVERAGE
DO YOU NEED TO INSURE ANY RENTED OR BORROWED PRODUCTION EQUIPMENT?
SELECT LIMITS
  1. (What does this mean? Watch the video here.)

*NOTE: The ‘selected limits’ should be the total replacement cost value of all rented equipment from all rental houses/individuals at any one time, NOT the cost of the rental

SELECT YES OR NO
COVERAGE
CONTINUING RENTAL FEES
SELECT LIMITS

(IF YOU HAVE A CLAIM, THIS CONTINUES PAYING YOUR RENTAL INCOME TO THE PERSON/ORGANIZATION WHO IS RENTING THEIR EQUIPMENT TO YOU, UNTIL THE CLAIM IS CLOSED)

OWNED PRODUCTION EQUIPMENT
  1. (What does this mean? Watch the video here.)
OWNED MUSICAL INSTRUMENTS AND SOUND EQUIPMENT
  1. (What does this mean? Watch the video here.)
RENTAL REIMBURSEMENT (Select 1)
(What does this mean? Watch the video here.)

(IF YOU HAVE A VALID EQUIPMENT CLAIM, RENTAL REIMBURSEMENT PAYS FOR YOUR RENTAL FEES INCURRED IF YOU HAVE TO RENT EQUIPMENT TO CONTINUE YOUR OPERATIONS. PLEASE SELECT ONE OF THE 3 OPTIONS ABOVE IF YOU WISH TO ADD)


  1. (What does this mean? Watch the video here.)

(IF YES, WE WILL NEED A SCHEDULE OF ITEMS OVER $5,000 A PIECE (MAKE, MODEL, SERIAL NUMBER, AND REPLACEMENT VALUE INCLUDING SALES TAX. IF THESE ITEMS ARE NOT SCHEDULED, THERE WILL BE NO COVERAGE FOR THOSE ITEMS IN THE EVENT OF A CLAIM.)



Please Note: most equipment rental houses require this exclusion to be removed.

  1. PLEASE SELECT ONE OF THE FOLLOWING DEDUCTIBLES
    (What does this mean? Watch the video here.)

NOTE: This IS NOT Workers Compensation Coverage. It reimburses medical expenses sustained to cast or crew while participating in the filming operations, excess of any existing health insurance available. If anyone is already covered by Workers Compensation, then they are not eligible for Accident Medical Coverage

SELECT YES OR NO
COVERAGE
ACCIDENT MEDICAL
SELECT ONE LIMIT

(PLEASE LIST ALL THE NAMES AND ADDRESS OF THE LOCATIONS AND RENTAL HOUSES THAT REQUIRE TO BE NAMED AS A CERTIFICATE HOLDER)

  1. 1 Name
  2. A Full Address
  3. B Type Of Certificate Holder (I.E. RENTAL HOUSE, LOCATION, ETC.)
  1. 2 Name
  2. A Full Address
  3. B Type Of Certificate Holder (I.E. RENTAL HOUSE, LOCATION, ETC.)
  1. 3 Name
  2. A Full Address
  3. B Type Of Certificate Holder (I.E. RENTAL HOUSE, LOCATION, ETC.)
  1. 4 Name
  2. A Full Address
  3. B Type Of Certificate Holder (I.E. RENTAL HOUSE, LOCATION, ETC.)

NOTE: Please send a list with additional Certificate Holders if necessary

  1. There may be an Additional Premium due for any changes made after the policy is bound.
  2. Coverage is only valid within the United States. I understand that if I have international activities, I will have to purchase a foreign production policy.
  3. This quoted policies will not include Cast Coverage , Errors & Omissions (the Content or Media Liability of your Film/Project), or any other coverage that was not requested to be quoted on this application. A field left blank will be assumed to mean that you do not want that coverage.
  4. A Broker Fee, Policy Fee and/or Administrative Fee may be charged by Athos Insurance Services for the placement and administrative services provided. All fee amounts will be listed and disclosed on the quote. This fee is fully earned upon binding coverage.
  5. I verify that all the information provided on this application is true and accurate to the best of my knowledge and that I have read and accept the terms above. Misrepresentation of information may make my coverage null and void.
  6. I understand that it is my responsibility to provide Athos Insurance with any insurance requirements I have signed or agreed to, before purchasing any policies. I acknowledge that failure to provide Athos with these requirements may prevent me from receiving the most proper insurance policies and can result in additional premiums due to satisfy requirements after policies have been purchased.
  7. I understand that this application is just a starting point to apply for insurance and may result in additional questions from Athos Insurance, in order to receive better quote options.
(Please type in your full name)
I HAVE READ AND ACKNOWLEGED THE ABOVE