ABOUT THE EVENT
Name of Business:
Type of Business:
Description of Business:
Are you a non-profit organization?	CHOOSE ONE NO YES
Start Date:
End Date:
Is the event indoors or outdoors?	CHOOSE ONE INDOORS OUTDOORS BOTH
Is the event indoors or outdoors?	CHOOSE ONE INDOORS OUTDOORS BOTH
Alcohol served?	CHOOSE ONE NO YES
Estimated number of spectators:	(DAILY)       (TOTAL)
Location Capacity:
Budget:	$
Estimated Gross Receipts:	$
Year Started:		Years experience in industry:
VENUE INFORMATION
ADDRESS 1:
ADDRESS 2:
CITY:
STATE:
ZIP:
Full Time Employees	Part-Time?
Smoke Detectors:	Yes No    Sprinklers: Yes No
Are you responsible for parking?	Yes No
Who is handling the security?
COVERAGE INFORMATION
Liability Limits (per occurrence):	$ CHOOSE ONE $500,000 $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 OTHER - ENTER TO RIGHT
Liability Limits (aggregate):	$ CHOOSE ONE $500,000 $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 OTHER - ENTER TO RIGHT
Autos:	# Rented       # USED BY EMPLOYEES
Liquor liability?	CHOOSE ONE Yes No       ESTIMATED LIQUOR SALES:$
	CHOOSE ONE Yes No
Any special safety procedures or first aid information?
	CHOOSE ONE Yes No      In an enclosed shopping mall?
	CHOOSE ONE Yes No      Any chemical exposure?
	CHOOSE ONE Yes No      Any armed security guard or dogs?
	CHOOSE ONE Yes No      Any work performed above 2 stories?
Prior losses or claims?	CHOOSE ONE Yes No
***	Do you currently have insurance (if yes, with what carrier?)
	Do you have any other information about your business, or comments that you would like to share? Please place special requests here, such as extra coverage for special items..
NO COVERAGE IS BOUND, OFFERED, ISSUED THROUGH THIS ELECTRONIC COMMUNICATION, ALL POLICIES MUST BE UNDERWRITTEN AND APPROVED BY THE CARRIER. DO NOT CANCEL YOUR CURRENT INSURANCE.