1. Have you had any prior entertainment / production insurance for your company ?
  2. What company did you receive the prior insurance from?
  3. Have you had any claims or losses in the last 3 years?
  4. IF YES, Please describe the claim, including the settlement amount.
  1. Will any production activities take place outside of the U.S.?
  2. 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?
  3. IF YES, Please describe
  4. What is the total number of years of production experience (the owner of the company)?
  5. Will you be using any drones, Unmanned aerial vehicles or remote controlled aerial devices in this project?
  6. Do you have insurance coverage for this exposure elsewhere?
  7. Please Provide Detailed Description of Business Operation

(EXCLUDING AUTOS OR VEHICLES)

Do you need to insure any rented or borrowed production equipment?
SELECT YES OR NO


Do you need to insure any rented or borrowed props, sets, or wardrobes?
SELECT YES OR NO
NOTE:THE ABOVE LIMITS ARE THE COMBINED TOTAL REPLACEMENT COST VALUE OF ALL EQUIPMENT AND/OR PROPS RENTED FROM ALL RENTAL HOUSES / INDIVIDUALS AT ANY ONE TIME, NOT THE COST OF THE RENTAL EQUIPMENT
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)

  1. (What does this mean? Watch the video here.)
  2. Please Note: *Most equipment rental houses require having coverage for theft from an unlocked vehicle.
  3. (What does this mean? Watch the video here.)
(This is to insure rented or borrowed vehicles used for production purposes.)
COVERAGE
SELECT YES OR NO
NON-OWNED & HIRED AUTO LIABILITY
NON-OWNED & HIRED AUTO PHYSICAL DAMAGE
Would you like to add Worker's Compensation?
NUMBER OF CAST MEMBERS
NUMBER OF CREW MEMBERS

NAME OF OWNERS MUST BE LISTED (The below individual(s) will be excluded from Workers Compensation coverage)
(PLEASE SELECT & COMPLETE ONLY ONE OF THE THREE GENERAL LIABILITY BOXES BELOW)
Select Limits
SELECT YES OR NO
COVERAGE
GENERAL LIABILITY
3rd Party Property Damage (Damage to property at rented locations i.e. floors, walls)
CITY / SPECIAL CERTIFICATES (I.E. FILM PERMIT OFFICE)
WAIVER OF SUBROGATION
PRIMARY AND NON-CONTRIBUTORY WORDING

SELECT YES OR NO
COVERAGE
Excess Limit Desired
EXCESS LIMIT




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
Would you like to add Accident Medical Coverage in this policy?
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)

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

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

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

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

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



  1. Coverage CANNOT be CANCELLED once BOUND. Minimum Premiums and Fees are FULLY EARNED and NON-REFUNDABLE upon binding (ordering) your insurance policy.
  2. There may be an Additional Premium due for any changes made after the policy is bound.
  3. Coverage is only valid for ONE project. Multiple projects require multiple policies or one Annual policy, which must be quoted separately.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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