Personal Information
Your name
IndividualCorporationPartnership
Email
(important if you'd like to receive your quote via email)
Address
City
State CALIFORNIA
Zip
Home phone
Work phone
Fax
Event Information
Address of Event
County
Describe location of event
Date of event
/ / (mm/dd/yy)
Coverage dates req'd
to (mm/dd/yy)
Time of event
From a.m. p.m. to a.m. p.m.
Estimated attendance per day
Total estimated participants
Gross receipts
$
Maximum capacity of location
Detailed description of event
Event will be held:
indoorsoutdoors
Seating will be:
reservedgeneral admission
Crowd control:
ushersprivate securityoff-duty police armed unarmed
other (be specific)
Applicant's experience in conducting events of this or a similar nature
Any celebrities to be present
yes no
If yes, who?
Will bleachers or platforms be used? yes no
If yes: permanentportable
Construction: woodsteelconcreteother
Height in feet Age Condition
Does event involve any hazards? (Check any that apply) fireworksamusement rides/devicesfood sales alcoholic beverage sales
Interest of applicant
sponsor operator
If applicant is sponsor, does operator have liability insurance?
Limit carried
Name of company
Have certificates of insurance been obtained from operator?
Does applicant agree to hold harmless any third party?
Is applicant held harmless by others?
Loss experience from prior events of same or similar nature:
Date of loss
Nature of loss
Amount paid or outstanding
Products coverage desired?
Request for additional insured:
Name
State
CALIFORNIA
How would you like to receive your Special Events Insurance Quote?
Call me U.S.Postal Email Fax
