Request a Quote for Film Production Insurance

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Comments

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

Insured Information

Insured Name (business, organization, dba etc. name that you operate under)*

Business Type*

Other Business Type*

Contact Address (you/your organization)*

Street Address City State ZIP Code

***Must have a United States address to be eligible for coverage (events taking place internationally can still be considered as long as policy holder is domiciled in the US)

Contact Name*

Contact Phone Number*

Contact Email*

Eligibility

Description of business operations*

Number of Employees*

Will the production include any Hard-Core or Soft-Core pornography?*

Yes

Please explain why you answered yes to above*

Any unprotected or open heights above 15 feet?*

Yes

Please explain why you answered yes to above*

Any employees supplied to or from an employee leasing operation (i.e. PEO)?*

Yes

Please explain why you answered yes to above*

Insurance History

Any Insurance declined or cancelled in the past 3 years?*

Yes

Please explain why you answered "yes" to above*

Any Insurance losses in the past 3 years?*

Yes

Please explain why you answered "yes" to above*

Production #1

Production Name*

Production Type*

If Other is checked, please production type*

Gross Production Cost*

Production Start Date*

Production End Date*

Production Synopsis*

Type of Music*

Music Decade*

Artist's Name*

Production Location

Will the production take place at a single location, or will multiple locations be used?*

Single Location (one address)

Multiple Locations

Is the Production location in the United States?*

Yes - production location is in the United States

No - production location is in Canada

No - production location is international (not in the US or Canada)

Location Name*

Address*

Street Address Address Line 2 City State ZIP Code

Address*

Street Address Address Line 2 City Province Postal Code

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is the production location in the United States?*

Yes - production location is in the United States

No - production location is in Canada

No - production location is international (not in the US or Canada)

Production Location #1*

State

Please choose the state in which production activities will take place.

Add a second state where production activities will occur?*

Yes

Production Location #2*

State

Please choose the state in which production activities will take place.

Add a third state where production activities will occur?*

Yes

Production Location #3*

State

Please choose the state in which production activities will take place.

Add a fourth state where production activities will occur?*

Yes

Production Location #4*

State

Please choose the state in which production activities will take place.

Add additional states where production activities will occur?*

Yes

List additional states below where production activities will occur:*

Production Province #1*

Province