National Provider of Sports & Entertainment Insurance

 

13100 Shire Lane    Fort Myers, FL    33912

 (888) 288-1829 tel (630) 393-5666 fax

info@dhcins.com

 

HOME PROGRAMS FAQ & LINKS CONTACT

Special Events Liability Insurance Request for Quotation

Please complete the following information.  Once this request is received, a quotation will be sent within one business day.  As special events vary, some questions may not be applicable.  Please indicate "N/A" where necessary.

 

If you are looking for VENDORS Insurance, please CLICK HERE.

 

Please note that we are unable to provide coverage for the following events:  Air Shows, Ballooning Events, Skydiving Events, War Games, Cattle Drives, Abortion Rights Rallies, Pro Choice Rallies, Protest Events, Dunk Tanks, Trampolines, Moonwalks, Water Slides, Auto Racing, Motorcycle Racing, Snowmobile Racking, Demolition Derbies, Hot Air Balloons, Bungee Jumping, and Concerts with a propensity towards violence (rap, punk rock, etc.).

 * = required field

Name *  

Email*

   Fax 999-999-9999

Street Address*  
City*    State*     Zip Code * 
Phone*    999-999-9999
How do you wish to receive your Quotation?* Email  Fax   Mail
Dates of Event*     
Time(s)*  

Name of Event*

 

Location of Event*

 

Name of Facility*

 
Does the Facility carry Liability Insurance?*    Limits
Description of Event*  
List any Additional Insured Names, Addresses and Relationship to the applicant to be added to the policy.  

Indoors or Outdoors

Is this Event Located Indoors or Outdoors?   Indoors   Outdoors

                  If Outdoors, is the Area Fenced or Enclosed? Yes  No 

 

Parking

Are you Responsible for Parking?  Yes    No

                  If Yes, Square Footage of Parking Area

 

Scope of the Event

Seating Capacity

Price of Admission

 

Estimated Attendance per Day

Estimated Gross Receipts

 

Number of Tickets Printed

Estimated Total Payroll

 

Number of Tickets Sold to Date

 

 

 

Limits of Liability Requested

General Aggregate

 

Medical Payments

 

Products Aggregate

 

Fire Damage

 

Each Occurrence

 

Personal / Adv Injury

 

Will there be any Exhibitions, Demonstrations, Parades or Pageants?Yes  No    

              If Yes, Describe

 

 

Seating

Are Seats of Temporary or Permanent Construction? 

Temporary   Permanent   Both   N/A

Is Seating Reserved or General Admission? Reserved   General Admission Both N/A

Describe Type of Seating Provided

(Bleachers, Folding Chairs, etc.)

 

Event Setting

 

If the Event is Outdoors, does the event end at last ninety(90) minutes prior to sundown? Yes  No

  If No, is there Permanent Lighting over all Spectator Areas and Parking Lots?  Yes   No
 

Stage

If a stage is involved, is the Stage of Temporary or Permanent Construction? Temporary   Permanent   Both   N/A

  If Temporary, Who is Responsible for Set Up of the Stage?  
  If other than Applicant, is a Certificate of Insurance Provided?  Yes  No
  If other than Applicant, is Applicant Named as an Additional Insured?  Yes  No
 

Lighting

Is Temporary Lighting involved? Yes  No
  If Yes, Who is Responsible for Hook Up of Lighting? 
  If other than Applicant, is a Certificate of Insurance Provided?  Yes   No
  If other than Applicant, is Applicant Named as an Additional Insured?   Yes   No
 

Tent

Is a Tent Involved?

Yes   No

  If Yes, Who is Responsible for Set Up of Tent? 
  If other than Applicant, is a Certificate of Insurance Provided?  Yes   No
  If other than Applicant, is Applicant Named as an Additional Insured?   Yes   No
 

Ushers

Are Ushers used for Seating Purposes?

Yes   No

  If Yes, Who is providing the Ushers?
  If other than Applicant, is a Certificate of Insurance Provided?  Yes   No
  If other than Applicant, is Applicant Named as an Additional Insured?   Yes   No
 

Vendors or Trade Booths

What is the number of Vendors or Trade Booths?

What Goods are to be displayed?
Are all Goods Finished Products or Demonstrations? Finished Products   Demonstrations   Both
Are there any Cooking Demonstrations? Yes   No
Are Vendors or Trade Booths Required to Provide a Certificate of Insurance?   Yes   No
 

Advertising

How is Advertising being used at the Event?

 

Food & Drinks

Who is Providing the Food and/or Drinks?

 

If other than Applicant, is a Certificate of Insurance Provided?  Yes   No

 

If other than Applicant, is Applicant Named as an Additional Insured?   Yes   No

 

Liquor

Is Liquor to be Sold at this Event? Yes   No

If Yes, Complete the following Questions if you would like a Quotation for Optional Liquor Liability Coverage.

  Estimated Number of Attendees Consuming Alcohol Daily      
  Is Applicant the Sole Vendor of Alcohol at the Event?  Yes   No
        If No, please list the Number of Vendors Serving Alcohol     
        Are all Participating Alcohol Vendors required to carry Minimum Liquor Liability Limits for this Event?   Yes   No
  Will Alcohol be Dispensed by a Professional Bartender?   Yes   No
        If No, Describe How and By Whom Alcohol will be Dispensed
        Describe Training and/or Experience of Persons Serving Alcohol
 

      What measures are in place to Prevent Service of Alcohol to Minors and/or Intoxicated Persons?

     

  Is a Liquor License Required for this Event? Yes   No
        Does Applicant have a Valid Liquor License?   Yes   No
  Number of Bars or Areas at which Alcohol will be Dispensed at this Event    
        Is Alcohol Consumption Confined to this (these) Areas?   Yes   No
        If No, please Describe 
        Will there be an Open Bar? Yes   No
        Will Alcohol be Sold by the Drink? Yes   No
        Cost per Drink
        Is BYOB Permitted? Yes   No
  Will Food be Sold or Served with the Alcohol?  Yes   No
        If Yes, Describe Food Available
  Estimated Gross Receipts per Day: Alcohol           Food        
  Total Estimated Gross Receipts for Event: Alcohol           Food        
  Has the Applicant Received any Fines or Citations in the Last 5 Years?   Yes   No
        If Yes, Describe 
  Has the Applicant had a Liquor Loss in the Last 5 Years?   Yes   No
        If Yes, Describe 
     
 

Cooking

 

Are there Cooking Facilities on the Premises?

Yes   No
 

If Yes, What type of Fire Protection is Present?

 

Overnight Accommodations

 

Is the Applicant Providing any Overnight Accommodations such as Camping?  Yes   No

 

If Yes, Describe 

 

Security

 

Who is Responsible for Providing Security?

 

If other than Applicant, is a Certificate of Insurance Provided?  Yes   No

 

If other than Applicant, is Applicant Named as Additional Insured?  Yes   No

 

Is the Security Provided Armed or Unarmed?

Armed   Unarmed
 

If the Event is being held on a Street or Other Public Place of Vehicular Access, What Protection is being Used between the Street and the Sidewalk? 

 

Parade

 

Does the Event involve a Parade?

Yes   No
 

If Yes, How many Units will there be?

(each float, band, or car is a unit)
 

Will Anything be Thrown from the Units?

Yes   No
 

      If Yes, What will be Thrown from Units?

 

What is the Length of the Parade in Blocks?

   Length of Time:
 

Estimated Number of Spectators

 

Fireworks or Pyrotechnics

 

Are Fireworks or Pyrotechnics to be Used?

Yes   No
 

If Yes, Describe 

 

Hold Harmless Agreements

 

Is the Applicant Signing any Hold Harmless Agreements?  Yes   No

 

If Yes, With Whom and What Responsibilities? 

A Copy of the Agreement(s), if available, should be faxed to (630)393-5666 or emailed to info@dhcins.com after you submit this request.

Is the Applicant being Held Harmless by Others?  Yes   No

 

A Copy of the Agreement(s), if available, should be faxed to (630)393-5666 or emailed to info@dhcins.com after you submit this request.

 

Prior Experience

 

Has this Event been held in the past by the Applicant?

Yes   No
 

If Yes, for how many years?  

Describe any Losses over $5,000.00  

Has your Prior Insurance Ever Been Cancelled?

Yes   No

Has your Prior Insurance Ever Refused to Renew?

Yes   No

Do You have a Risk Management Plan?

Yes   No
     

After you submit this Request, please fax or email the following items:

  • Premium and Loss Experience for the Past 5 Years

  • Copies of Leases and Hold Harmless Agreements

  • Brochures of the Event

  • Diagram of Location(s) to be used

Fax:   (630)393-5666          Email:  info@dhcins.com

 

 

 

This summary of coverage and exclusions is no substitute for reading the entire policy.  To receive an entire policy, contact DHC Insurance, L.L.C. 

 

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly provides false information on 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 DHC Insurance, L.L.C.

 

Authorized Electronic Signature*:  
   
 

 

This form is not for VENDORS Insurance.  If you are looking for VENDORS Insurance, please CLICK HERE.

 

 

 


DHC is a USA company and can not provide coverage outside of the USA.

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13100 Shire Lane   |   Fort Myers, FL   |   33912   |  (888) 288-1829 tel   (630) 393-5666 fax

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