SPECIAL EVENT INSURANCE POLICY QUOTE

If you have a current policy, it is often helpful to fax us a copy,
so that we may compare the coverage.
Our fax number is (949) 270-0608.

DOWNLOADABLE APPLICATION (Fax to 949-270-0608)

ABOUT THE OWNER OR COMPANY

   
First Name:  
Last Name:  
Address:
City:       State:
Phone:   Zip Code
   
E-mail:
Confirm E-mail:
Website  
Tax ID #  

 

 

ABOUT THE EVENT

Name of Business:  
Type of Business:
Description of Business:
Are you a non-profit organization?
Start Date:  
End Date:  
Is the event indoors or outdoors?
Is the event indoors or outdoors?
Alcohol served?
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:    Sprinklers:
Are you responsible for parking?
Who is handling the security?
   
   
   

COVERAGE INFORMATION

   
Liability Limits (per occurrence): $
Liability Limits (aggregate): $  

 

   
Autos: # Rented       # USED BY EMPLOYEES
   
Liquor liability?       ESTIMATED LIQUOR SALES:$
    
Any special safety procedures or first aid information?
       In an enclosed shopping mall?
       Any chemical exposure?
       Any armed security guard or dogs?
       Any work performed above 2 stories?
   
Prior losses or claims?  
   
*** 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.

 

DOWNLOADABLE APPLICATION

(Fax to 949-270-0608)

 
 
If you are not sure of exactly what you need, make sure to at least give us a description of your vehicle and we will send you a base quote that we can later adjust to find what is right for you.

 

Why choose us as your insurance broker?

 

 

 

 

 
If you have more than one LOCATION, please tell us about the second car in the additional information section.

 

 

 

Need help?

(949) 270-0609

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Liability limits needed may be found in your rental agreement.
 
 

Copyright 2009 Stratum Insurance Agency, LLC