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Legal business name/DBA*

Business Type*

Other Business Type*

Mailing address (No PO Box)*

Street Address City State ZIP Code

Contact Name*

Contact Phone Number*

Contact Email*

Event Start Date*

Event End Date*

Event Description*

Venue Name*

Venue Address*

Street Address City State ZIP Code

Is the event*

Indoors

Outdoors

Both indoors and outdoors

Will adverse weather conditions preclude the fulfillment of the event?*

Yes

Explain*

Can all aspects of the event proceed in continuous moderate rain fall and/or wind speeds of up to 30mph?*

Yes

Number of years you have held this event (if first year type zero)*

Estimated gross revenue of the event*

Estimated expenses of the event*

Has the present management or any prior management ever had a claim/loss for this event?*

Yes

Comments (if there is a specific cause of cancellation you are looking for protection against please denote)

DECLARATION FOR SUBMITTING

To the best of my knowledge and belief the information provided in this application, whether in my own hand or not, is true and I have not withheld any material facts. I understand that Non-disclosure or misrepresentation of a material fact will entitle the company to void the Insurance. I understand that submitting this Application does not bind me to complete the insurance but agree that should an insurance policy be issued, this Application and the statements made therein shall form basis of the insurance policy.

(By clicking “submit” below you are agreeing to the following statement)

This field is for validation purposes and should be left unchanged.

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DECLARATION FOR SUBMITTING