Annual Productions Application

STUNTS / FIGHT SCENES

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Will there be physical contact?

Yes No

Will there be weapons used?

Yes No

What type?

Will there be a stunt coordinator on set?

Yes No

Please fill details!

MOTORIZED VEHICLES

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Type of vehicle(s)

Total # of vehicle(s)

Will there be speeding, skidding or car chase scenes?

Yes No

Please describe all activities

Will there be a precision driver hired?

Yes No

Please fill details!

PYROTECHNICS

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

How will the pyro effect be achieved?

How far will it be from cast and crew? (in feet distance)

How far will it be from private property? (in feet distance)

Will there be certificates and/or permits obtained from the fire department?

Yes No

Will there be a professional pyro technician on set?

Yes No

Please fill details!

ANIMALS

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Type of animal

If it is a dog, what is the breed?

Will there be a professional animal handler on set?

Yes No

Please fill details!

WATERCRAFT

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Type of watercraft

Type of body of water

Please fill details!

BLANKS, SQUIBS, OR GUNS

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Type of weapon

Will any effect be achieved in post production?

Yes No

Will there be a stunt coordinator on set?

Yes No

Please fill details!

FILMING ABOVE AND / OR UNDERWATER

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Total replacement cost value of equipment that will be above or under water

Please fill details!

FILMING OUTSIDE THE UNITED STATES

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Please List ALL cities, countries, and regions you will be filming in outside of the United States

Please fill details!

AIRCRAFT, HELICOPTERS OR DRONES

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Will you be filming with an aircraft, helicopter, or drone that you own?

Yes No

I will be using Drone Aircraft Helicopter

what is the replacement cost value of the drone?

Will you be filming with an aircraft, helicopter or drone you rent or hire?

Yes No

I will be using Drone Aircraft Helicopter

what is the replacement cost value of the drone?

Please explain why the drone will be neither owned or rented/hired

Please fill details!

SPORTS ACTIVITIES

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Please list the types of sports involved

Total number of athletic participants?

Will this include professional athletes?

Yes No

Please fill details!

LIVE HIP HOP OR ELECTRONIC DANCE CONCERT/PERFORMANCES

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Are you the organizer or promoter of the entire event?

Organizer
Promoter

Are you responsible for insuring the entire event itself?

Yes No

Are you providing filming and/or event services for the event?

Yes No

Please describe

Please fill details!

OTHER HAZARDOUS ACTIVITIES

Tentative Stunt Shoot Start Date

Tentative Stunt Shoot End Date

Details of Scene

Tentative Number of scenes

Please fill details!

OTHER HAZARDOUS ACTIVITIES

Stunt Shoot Start Date

Stunt Shoot End Date

Details of Scene

Number of scenes

Please fill details!

NUDITY SCENES

Stunt Shoot Start Date

Stunt Shoot End Date

Details of Scene

Number of scenes

Please fill details!

APPLICANT / COMPANY NAME

ENTITY TYPE (Please Check)

INDIVIDUAL PARTNERSHIP LLC CORPORATION OTHER

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

Phone

Mailing Address

Zip Code

City

State

Company Website

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

PRIOR INSURANCE

Have you had any prior entertainment / production insurance for your company ?

Yes No
IF YES, What company did you receive the prior insurance from?
Have you had any claims or losses in the last 5 years?

Yes No
IF YES, Please describe

UNDERWRITING QUESTIONS

Will your project have any stunts or hazardous activities including (but not limited to) stunts, fight scenes, motorized vehicles, animals, pyrotechnics, fire, watercraft, blanks, squibs, guns, filming above or under water, filming outside the continental United States, aircraft, helicopters, drones, sports activities, live hip hop performances, or live Electronic Dance Music performances?

Yes No
IF YES, Please describe
Do you own or have any drones, Unmanned aerial vehicles or remote controlled aerial devices exposures or operations?

Yes No
Do you have insurance coverage for this exposure elsewhere?

Yes No
Please Provide Detailed Description of Business Operation
Will there be any unprotected or open heights above 15 feet?

Yes No
Will you have any scenes with partial or full nudity?

Yes No

Please indicate if your production/project will include any of the below. If you check off a box, please provide more information on the activity including a description, SHOOT DATES AND NUMBER OF SCENES: Please select atleast one activity

STUNTS / FIGHT SCENES

MOTORIZED VEHICLES

PYROTECHNICS

ANIMALS

WATERCRAFT

BLANKS, SQUIBS, OR GUNS

FILMING ABOVE AND / OR UNDERWATER

FILMING OUTSIDE THE UNITED STATES

AIRCRAFT, HELICOPTERS OR DRONES

SPORTS ACTIVITIES

LIVE HIP HOP OR ELECTRONIC DANCE CONCERT/PERFORMANCES

OTHER HAZARDOUS ACTIVITIES

FALLS OVER 3 FEET

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Alert

Since you have indicated you will be taking your equipment above/under water, please complete the water stunt scene involved with your production

Other Content Types

Please explain what other types of content you produce (Other than Documentaries, Informational, Educational, Educational, and music videos)

AUTO LIABILITY

(This is to insure rented or borrowed vehicles used for production purposes.)

SELECT YES OR NO

COVERAGE

Yes No

NON-OWNED & HIRED AUTO LIABILITY

WHAT IS THE COST OF HIRE (rental cost)?

SELECT YES OR NO

COVERAGE

Yes No

NON-OWNED & HIRED AUTO PHYSICAL DAMAGE

MAXIMUM # VEHICLES YOU RENT PER PROJECT?

MAXIMUM # VEHICLES YOU RENT ANNUALLY?

TOTAL NUMBER OF VEHICLE RENTED DAY ANNUALLY?

WHAT KIND OF VEHICLE(S) ARE YOU RENTING?

Yes No

Do you allow employees to use their own personal vehicles for your business?

Yes No

Do all employees who regularly use their cars for business purposes carry minimum personal auto limits?

Yes No

Do you obtain Motor Vehicle Reports or keep driver license information on file?

WORKERS COMPENSATION

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

SELECT YES OR NO

COVERAGE

SELECT LIMITS

Yes No

WORKERS COMPENSATION

NUMBER OF CAST MEMBERS1

HOW MANY ARE FULL-TIME?

PART TIME?

NUMBER OF CREW MEMBERS

HOW MANY ARE FULL-TIME?

PART TIME?

TOTAL PAYROLL FOR ALL CAST AND CREW MEMBERS EXCLUDING OWNERS

Name(s) of Owner(s) must be listed; the below individual(s) can be included or excluded from Workers Compensation:

FULL NAME TITLE Exclude from coverage / Include in coverage Owner's Annual Payroll

Federal ID Number of Corporation or Social Security Number of owner

SELECT YES OR NO

COVERAGE

Yes No

WAIVER OF SUBROGATION

WHAT IS THE NAME OF THE COMPANY REQUESTING THE WAIVER OF SUBROGATION?

OPTION 1

NO GENERAL LIABILITY NEEDED By checking this box, I confirm I am not requesting any general liability insurance and will not need to name any entities or vendors as additional insured.

OPTION 2

EQUIPMENT LIABILITY - THIS IS GENERAL LIABILITY TO SATISFY RENTAL HOUSE REQUIREMENTS ONLY By checking this box, I 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 understand that the liability is NOT going cover any other activity or liability associated with producing films, productions or events including obtaining locations/permits.

SELECT YES OR NO
Yes No

COVERAGE

GENERAL LIABILITY

Select Limits

$1,000,000 / $1,000,000 $1,000,000 / $2,000,000 $1,000,000 / $3,000,000 $1,000,000 / $4,000,000 $1,000,000 / $5,000,000

Would you like to add $5,000 of Medical Expense Coverage for Spectators? (Spectators are bystanders who are neither cast nor crew members)

Yes No

OPTION 3

PRODUCTION LIABILITY - THIS IS GENERAL LIABILITY FOR ALL OTHER PURPOSES SUCH AS LOCATIONS, PERMIT OFFICES, AND RENTAL HOUSES Liability for Locations & to Rent Equipment—By checking this box, I am requesting a quote for production liability insurance, Including location liability for film permits. This also includes liability to rent equipment.

SELECT YES OR NO

COVERAGE

SELECT LIMITS

Yes No

GENERAL LIABILITY

$1,000,000 / $1,000,000 $1,000,000 / $2,000,000 $1,000,000 / $3,000,000 $1,000,000 / $4,000,000 $1,000,000 / $5,000,000

Yes No

3RD PARTY PROPERTY COVERAGE (DAMAGE TO PROPERTY AT RENTED LOCATION I.E FLOORS, WALLS)

$250,000 $500,000 $1,000,000

Yes No

CITY / SPECIAL CERTIFICATES (I.E. FILM PERMIT OFFICE)

Yes No

WAIVER OF SUBROGATION

Yes No

PRIMARY AND NON-CONTRIBUTORY WORDING

Yes No

Do music video productions make up more than 50% of your total productions?

EXCESS LIABILITY

Excess liability adds additional liability limits on top of your general liability limit. For example, if you have a $1M per occurrence and $1M aggregate limit for general liability coverage, adding a $1M excess liability policy will provide a total coverage of $2M per occurrence and $2M aggregate general liability limits.

SELECT YES OR NO
Yes No

COVERAGE
EXCESS LIMIT

SELECT LIMITS

PRODUCTION / PROJECT INFORMATION

Do you produce content other than Documentaries, Informational, Commercials, Educational, or Music Video content?

Yes No

Will any of your finalized or potential projects include any of the below filming exposures?(Please Check All That Apply - If None, please skip this section)

Please note: our annual policies typically exclude these types of productions below (unless specifically added to the policy and paid the additional premium). If you have any projects that will include these type of activities, please notify us in writing (email) to ensure proper coverage. This includes future projects that come up during the policy term.

Webisodes

Podcasts

Any project involving persons under the age of 18

Any single production with total budget in excess of $500,000

Short Films

Feature Films

Reality TV, Scripted TV, TV Pilots

Filming with explicit sexual content or pornography

Foreign Filming (Outside of U.S)

Hidden Camera Filming

Filming with watercraft, aircraft, car racing/chasing or pyrotechnics

Coastal filming including lakes, rivers or large bodies of water

Filming period longer than 12 weeks

Filming with vloggers (YouTube Celebrities/Social Media Influencers)

Filming with use of any stunt activity

Filming with use of any weapon

Filming with use of any animal

Filming with camping or rock climbing adventures

Typically how old are the individuals?

What type of film projects will you be doing with the minors?

Please describe in more detail the involving persons under the age of 18 projects you’re filming under this category

What is the maximum budge for any one of your short film projects?

Will your short films film take 30 or more days to film?

Yes No

Please describe in more detail the Short Films projects you’re filming under this category

Please describe in more detail the Webisodes projects you’re filming under this category

Please describe in more detail the Podcasts projects you’re filming under this category

Please describe in more detail the single production with total budget in excess of $500,000 projects you’re filming under this category

Please describe in more detail the Feature Films projects you’re filming under this category

Please describe in more detail the Reality TV, Scripted TV, TV Pilots projects you’re filming under this category

Please describe in more detail the Filming with explicit sexual content or pornography projects you’re filming under this category

Please describe in more detail the Foreign Filming (Outside of U.S) projects you’re filming under this category

Please describe in more detail the Hidden Camera Filming projects you’re filming under this category

Please describe in more detail the Filming with watercraft, aircraft, car racing/chasing or pyrotechnics projects you’re filming under this category

Please describe in more detail the Coastal filming including lakes, rivers or large bodies of water projects you’re filming under this category

Please describe in more detail the Filming period longer than 12 weeks projects you’re filming under this category

Please describe in more detail the Filming with vloggers (YouTube Celebrities/Social Media Influencers) projects you’re filming under this category

Please describe in more detail the Filming with use of any stunt activity projects you’re filming under this category

Please describe in more detail the Filming with use of any weapon projects you’re filming under this category

Please describe in more detail the Filming with use of any animal projects you’re filming under this category

Please describe in more detail the Filming with camping or rock climbing adventures projects you’re filming under this category

NUMBER OF PROJECTS YOU ESTIMATE TO DO A YEAR

What is the Maximum Gross Production Cost for any one Project?

What is your estimated annual Gross Production Costs (your annual estimated costs to produce your films)?

PLEASE CHECK ALL THE BUSINESS OPERATIONS THAT APPLY:

% of business operations

Annual Gross Sales (Estimated)

PRODUCTION COMPANY

RENTAL OPERATIONS (RENTING EQUIPMENT TO OTHERS)

EVENT SERVICES (EVENT SET UP)

GRIP & LIGHTING

OTHER

Locations For Film/Project (City and state)

Will you ever rent any one location for more than 7 consecutive days for this project?

Yes No

MAXIMUM NUMBER OF DAYS FOR ANY ONE PROJECT

KEY PRODUCTION CONTACT (Must be Producer or Executive Producer)

Full Name Of Producer Or Executive Producer

Title

SSN OR FEIN Number

Federal Employment or Social Security Number

Driver License Number

Driver License State Of Issuance

INDEPENDENT CONTRACTORS DETAILS

Will you be using any Independent Contractors?

Yes No

What is the Estimated cost of hire (amount you pay) for your uninsured contractors?

What is the Estimated cost of hire (amount you pay) for contractors who have their own liability insurance?

Do you require your independent contractors, with their own insurance, to have at least a $1M limit and name your company as an additional insured?

Yes No

Save & Exit

OFFICE PREMISE LIABILITY

What is the location of your Office Premise

Other address

Same as mailing address

Mailing Address

Zip Code

City

State

OFFICE PREMISE LIABILITY

Yes No

SQUARE FOOTAGE OF OFFICE SPACE

NUMBER OF STORIES OF YOUR ENTIRE BUILDING
DOES YOUR OFFICE HAVE AN ALARM CONNECTED TO AN OUTSIDE MONITORING SERVICE?

Yes No
YEAR BUILDING WAS BUILT
YEAR YOUR BUILDING WAS UPDATED FOR

HEATING

ELECTRICAL

PLUMBING

ROOFING
WHAT KIND OF FOOT TRAFFIC DO YOU HAVE AT YOUR OFFICE?
IS YOUR BUILDING SPRINKLERED?

Yes No
Does your landlord require you to cover anything specifically in your lease?

Yes No

Please explain
Is your lease a Triple Net Lease?

Yes No

Do you need to cover the building?

Yes No

What is the replacement value of the Building that you need to cover?

Production & Sound Equipment / Inland Marine Equipment Floater (What does this mean? Watch the video here.)

Would you like a quote for any Owned or Rented Equipment?

Yes No

SELECT YES OR NO
Yes No

COVERAGE

DO YOU NEED TO INSURE ANY RENTED OR BORROWED PROPS, SETS OR WARDROBES?

SELECT LIMITS

WILL ANY OF YOUR RENTED PROPS, SETS, AND WARDROBES EQUIPMENT BE GOING ABOVE OR UNDER WATER? (What does this mean? Watch the video here.)

Yes No
IF YES, WHAT IS THE MAX LIMIT THAT WILL GO ABOVE OR UNDER WATER?

SELECT YES OR NO
Yes No

COVERAGE

DO YOU NEED TO INSURE ANY RENTED OR BORROWED PRODUCTION EQUIPMENT?

SELECT LIMITS

WILL ANY OF YOUR RENTED PRODUCTION EQUIPMENT BE GOING ABOVE OR UNDER WATER? (What does this mean? Watch the video here.)

Yes No
IF YES, WHAT IS THE MAX LIMIT THAT WILL GO ABOVE OR UNDER WATER?

*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
Yes No

COVERAGE

CONTINUING RENTAL FEES (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)

SELECT LIMITS

$2,500 $5,000 $10,000 $25,000

Yes No

OWNED PRODUCTION EQUIPMENT

Yes No

OFFICE EQUIPMENT AND FURNISHINGS

WILL ANY OF YOUR OWNED PRODUCTION EQUIPMENT BE GOING ABOVE OR UNDER WATER? (What does this mean? Watch the video here.)

Yes No
IF YES, WHAT IS THE MAX LIMIT THAT WILL GO ABOVE OR UNDER WATER?

Yes No

OWNED MUSICAL INSTRUMENTS AND SOUND EQUIPMENT

WILL ANY OF YOUR OWNED MUSICAL INSTRUMENTS & SOUND EQUIPMENT BE GOING ABOVE OR UNDER WATER? (What does this mean? Watch the video here.)

Yes No
IF YES, WHAT IS THE MAX LIMIT THAT WILL GO ABOVE OR UNDER WATER?

Yes No

RENTAL REIMBURSEMENT

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

(Select 1)
$5,000 $10,000 $25,000

WILL YOU OWN OR RENT ANY SINGLE ITEM OVER $150,000?

Yes No
Do you Ever Rent Any Equipment to Others unaccompanied by you? (What does this mean? Watch the video here.)

Yes No

Do you want to cover this equipment you rent out to Others unaccompanied by you?

Yes No
Cover The Equipment Limit
Do you want to cover Voluntary Parting Coverage?

Yes No
Voluntary Parting Coverage Limit

WHERE DO YOU STORE YOUR EQUIPMENT MAJORITY OF THE YEAR?
Does this location have an alarm system connected to a monitoring service?

Yes No
DO YOU TRAVEL OUTSIDE OF THE US MORE THAN 5 TIMES A YEAR WITH YOUR EQUIPMENT?

Yes No
IS ANY OF YOUR OWNED EQUIPMENT OVER $5,000 A PIECE?

Yes No

(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.)

Equipment Itemization

If any single item you are insuring is over $5000, please list it below. Please be sure to include sales tax in your replacement cost below.

Make	Model	Serial Number (not required)	Replacement Cost
			$

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

$250 $500 $1000 $2,500
Do you have any pre-existing damages on any of the equipment or items you are looking to cover on this policy?

Yes No
IF Yes, Please describe in detail.

If you had to fix the damages today, how much would it cost to fix everything (feel free to estimate)?
Will you ever take more than $25,000 total equipment to the country of Mexico?

Yes No
Please list the max value you will take to Mexico at any one time

What Cities will you be going to in Mexico?

What location(s) will you be filming at? (types of locations and venue name)

How will the equipment be stored overnight when not in use?

How will the equipment be transported to Mexico?
Will you ever take the proposed covered equipment to a country with US Sanctions?

Yes No
Which countr(ies) on the list will you travel to with your equipment? (please list all countries)
Please answer the following question based on how you plan to store your equipment during this policy term. This information is needed for underwriting purposes. Our policy covers theft from an unattended vehicle, regardless of how you answer the next question.

I Understand

Will you ever leave any of your equipment in a vehicle UNATTENDED?

Yes No
What is the maximum value of equipment left in your vehicle unattended?

How much of the $XXX may be left Unattended OVERNIGHT (maximum amount)?

How often does this happen?

Of the $XXXX of equipment that is left unattended, what is this gear comprised of (i.e. cameras, lenses, grip equipment, etc.)?

What kind of vehicle will you leave your equipment in (please describe in detail)?

What security measures will be taken to protect the equipment while left in a vehicle?

Does the equipment being insured have a GPS tracking device?

Yes No

Does the tracking device signal send to a monitored, remote device or security system?

Yes No

Does the vehicle have an alarm system?

Yes No

Does the alarm signal go to a monitored, remote device or security system?

Yes No

Please explain

Please select all that apply to how you may leave your equipment in an unattended vehicle:

I LEAVE MY EQUIPMENT IN AN UNATTENDED VEHICLE...

Only if it's an emergency or rare situation when I cannot store it anywhere else

For short periods of time (less than 30 minutes) including for food and bathroom breaks

For hours at a time, but not overnight

For days at a time, including overnight

All the time, including storing it in my vehicle

Other frequencies

Where will the vehicle be parked when left unattended? (mark all that apply)

City Street

Residential Street

Residential Garage (private home)

Residential Shared Garage (i.e. apartment complex)

Parking Garage:

If you marked “Parking Garage” please also mark all that apply below to the parking garage:

With 24 hour Security Guard and Surveillance

With limited surveillance

Restricted Access (Key Card)

Fenced

Gated

Lighted

Not Guarded

No Lot Attendant

Other:

Other

Save & Exit

Alert

Please note that in applying for liability to rent equipment, you will also need coverage for equipment coverage for the gear itself. Currently this application does NOT include equipment coverage.

Alert

Please note that pre-existing damages may not be covered in the event of a claim.

ACCIDENT MEDICAL COVERAGE

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

ACCIDENT MEDICAL COVERAGE

SELECT YES OR NO
Yes No

COVERAGE
ACCIDENT MEDICAL

SELECT ONE LIMIT
$10,000 per person per claim $25,000 per person per claim $50,000 per person per claim $100,000 per person per claim

Number Of Cast Members

Number Of Crew Members

Are any above members currently covered by workers compensation ?

Yes No

For the cast and crew, please provide a description of your cast and crew’s jobs and responsibilities

Are you filming outside of the US?

Yes No

Please list the countries you will be filming in
Please provide detailed scene information about what you will be filming
How many confirmed productions outside of the US will you have in the next 12 months?
How many days will the international shoots be (total days in a year)?
How many times will they go to this country in one year?
What types of productions will you be producing in these countries?
Will there be minors traveling?

Yes No
Are parents accompanying the minors?

Yes No

How Did you Hear About Us?

Where?

CERTIFICATE HOLDERS

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

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

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

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

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

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

PLEASE REVIEW THE FOLLOWING TERMS

There may be an Additional Premium due for any changes made after the policy is bound.
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.
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.
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.
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.
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.
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.
If I applied for Rented Equipment From Others coverage, I understand this limit is a shared limit of ALL equipment rented from ALL equipment owners and/or rental houses combined (maximum at any one time). If I rent more than my policy limit, it's my responsibility to contact Athos to increase this maximum limit BEFORE the rental occurs
If your total equipment limits need to be changed, you can revise your quote before purchase OR make changes after you’ve purchased your policy.
I have reviewed the Replacement Cost Valuation & Policy Limits Acknowledgement, which states: When entering values for Rented equipment and/or Rented Props, Sets and Wardrobes please use the REPLACEMENT COST value including SALES TAX. “Replacement Cost” is the cost to replace the gear with new or like-kind in quality equipment today. The Rented Equipment Limit is the total replacement cost value of the equipment you are renting from all owners/rental houses combined. If you do not have the exact limit, please feel free to provide an estimated total.

(Please type in your full name)

I HAVE READ AND ACKNOWLEGED THE ABOVE

DATE

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Replacement Cost Valuation & Policy Limits Acknowledgement

When entering values for Rented equipment and/or Rented Props, Sets and Wardrobes please use the REPLACEMENT COST value including SALES TAX. “Replacement Cost” is the cost to replace the gear with new or like-kind in quality equipment today.

The Rented Equipment Limit is the total replacement cost value of the equipment you are renting from all owners/rental houses combined. If you do not have the exact limit, please feel free to provide an estimated total.

If your total equipment limits need to be changed, you can revise your quote before purchase OR make changes after you’ve purchased your policy.

I understand all of the above

Scheduled Equipment Acknowledgement

The value of each scheduled item is designated and reserved for that specific item only. It does not transfer, cover, or apply to any other equipment items on your policy.

1. The sum of all scheduled equipment values will make up your Scheduled Equipment Limit
2. Our system will automatically split your Total Owned limit into scheduled and unscheduled categories
3. Scheduled Equipment + Unscheduled Equipment = Total Owned Equipment

Voluntary Parting Or False Pretense Condition for Coverage Acknowledgement

By selecting Voluntary Parting Or False Pretense coverage, I acknowledge:
1) I confirm and understand the following: For equipment I rent, loan or lease to others (unaccompanied by me), I will have a written contract or agreement that specifically requires the borrower, renter, or lessee to assume full responsibility for the risk of any loss or damage to the property from any cause whatsoever.

Would you like to do next?

Alert

Due to information being completed in the stunts section, workers compensation, accident medical coverage may not be eligible. When we review your application, our Athos Team member will confirm if this coverage is available.

Agree to Terms, Conditions, and Warranties

What would you like to do next?

Equipment Policy Term Mismatch

Since you have applied for short-term rented equipment coverage, please select one of the following

Keep Short-term Equipment Quote. I DO NOT want an annual equipment quote.

Apply for annual equipment coverage instead of short-term