1. DESCRIBE TYPE OF SEATING PROVIDED

  1. Who is responsible for setting up the stage?

  1. Who is responsible for hook up the lighting?

  1. Who is responsible for the set up of the tent?

  1. Who is providing the ushers?

  1. Who is responsible for providing food or drinks?


  1. Who is responsible for providing security?


SELECT YES OR NO
COVERAGE
EVENT LIABILITY
LIMITS
CITY / SPECIAL CERTIFICATES (I.E. FILM PERMIT OFFICE)
WAIVER OF SUBROGATION
PRIMARY AND NON-CONTRIBUTORY

PLEASE NOTE: NON-OWNED & HIRED AUTO PHYSICAL DAMAGE IS EXCLUDED

SELECT YES OR NO
COVERAGE
NON-OWNED & HIRED AUTO LIABILITY

PLEASE NOTE: DOES NOT COVER ANY AUTO PHYSICAL DAMAGE

SELECT YES OR NO
COVERAGE
LIMITS
RENTED EQUIPMENT
  1. WHAT DAY ARE YOU PICKING UP YOUR EQUIPMENT?
  2. WHAT DAY ARE YOU RETURNING YOUR EQUIPMENT

*NOTE: LIMITS FOR RENTED EQUIPMENT SHOULD BE THE TOTAL REPLACEMENT COST VALUE OF ALL EQUIPMENT AND/OR PROPS RENTED AT ANY ONE TIME.


PLEASE NOTE: THIS IS NOT WORKERS COMPENSATION COVERAGE. IT REIMBURSES FOR MEDICAL EXPENSES SUSTAINED TO CAST OR CREW WHILE PARTICIPATING IN THE FILMING OPERATIONS, EXCESS OF ANY EXISTING HEALTH INSURANCE AVAILABLE)

SELECT YES OR NO
COVERAGE
ACCIDENT MEDICAL
LIMITS

ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PROVIDES FALSE INFORMATION IN AN APPLICATION FOR INSURANCE MAY BE GUILTY OF A CRIME AND MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES. I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND COVERAGE IS NOT APPLICABLE UNTIL ACCEPTED BY ATHOS INSURANCE SERVICES.
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.