TENANT USER. Liability Insurance Program

Size: px
Start display at page:

Download "TENANT USER. Liability Insurance Program"

Transcription

1 TENANT USER Liability Insurance Program K&K Insurance 1712 Magnavox Way Fort Wayne, IN (800) Fax (260) CA # Program Description This insurance program is designed for the owners of premises/facilities that are rented or leased to tenants who organize short term special events that meet the following criteria: Total event attendance is 12,000 or less. Maximum number of consecutive event days (not including set-up or tear down) is 10. Event days are to be consecutive. Event is held at a single location. Event is held at an owned/registered location in the United States. List of Eligible Events This list does not encompass all events that may be included in each category. This is only a summary. If you conduct events not listed below, please contact K&K Insurance Group, Inc. at (800) Auctions Award Presentations Banquets/Luncheons Bar Mitzvah/Bat Mitzvah Bazaars Bingo Games Car Shows - Auto Static Only Charity Auctions/Benefits/Dances/Sales Concerts (Call for approval. No rock, rap or hip-hop) Conventions Debuts Debutante Balls Festivals (art, craft, ethnic, harvest) Flea Markets Graduations Job Fairs Lectures Meetings (business, civic club, evangelistic) Pageants Phone-A-Thons Picnics (no pool or lake activities) Poetry Readings Political Campaign Rallies Proms Quinceañera Recitals Religious Assemblies Reunions (family, class) Rummage Sales School Band/Drill Team Competitions School Carnivals (no rides) Scouting Jamborees Seminars Shows (animal/horse/livestock judging, antique, art, auto-static display, boat, business, consumer, craft, fashion, flower, garden, home, rv, trade, vacation) Social Gatherings/Receptions Speaking Engagements Stage Shows (dance, music, theatrical) Swap Meets Theatrical Performances/Musicals Weddings & Receptions Page DIS 10/06

2 Ineligible Events Certain event types are not eligible for coverage by this program. K&K reserves the right to decline any request for coverage. The ineligible event types include, but are not limited to the following: Activist Rallies/Marches/Literature Distribution Athletic Events & Competitions Historical Battle Reenactments In-or-On Water Activities Health Fairs Gun and Knife Shows Cinematography and Photography for Commercial Use Parades Rodeos (activities including, but not limited to, bull or bronco riding, steer roping, team roping, or barrel racing) Overnight Retreat Events requiring Liquor Liability Coverage (host liquor is included) Coverage for ineligible events or excluded coverage(s) may be considered with separate application. Contact K&K Insurance to obtain additional information regarding a tailor-made policy for your insurance needs. Liability Coverage and Limits Commercial General Liability coverage protects the insured against any liability claims for bodily injury and property damage arising out of the premises, operations, products and completed operations; and advertising and personal injury liability. There is no deductible that applies to liability claims. Coverage Option I Option II Limit General Aggregate $ 2,000,000 $ 2,000,000 Products-Completed Operations Aggregate $ 1,000,000 $ 2,000,000 Each Occurrence $ 1,000,000 $ 2,000,000 Personal & Advertising Injury $ 1,000,000 $ 2,000,000 Medical Expense $ 5,000 $ 5,000 Damage to Premises Rented to You $ 300,000 $ 300,000 Notable Exclusions Abuse or Molestation Aircraft/Hot Air Balloon Airport Amusement Devices, including but not limited to, any mechanical or non-mechanical ride, slide, water slide, pony rides, moonwalk or moon bounce, bungee (does not include video arcade or computer game) Animals (injury or death to any animal) Asbestos Claims arising out of the operations of concessionaires, exhibitors and vendors at your event. Employment-Related Practices Fireworks Designated Operations exclusionthose events listed as ineligible. Fungi or Bacteria Lead Motorized Vehicle/Motorcycle/Watercraft/ Powerboat practicing for, qualifying for or testing for any racing speed, demolition or stunting activity Nuclear Energy Performers Rodeo Activity Liability Coverage for concessionaires, exhibitors and vendors is available through the Concessionaires/Exhibitors and Vendors Program at K&K Insurance Group. Call for more information or go to our web site at Carrier Coverage is provided by a carrier rated A+ (superior) by AM Best. Page 2

3 How to Obtain a Quote 1. Complete and sign the application form provided with the brochure. 2. Remit the completed and signed application form, list of events, prior loss history, facility brochure, and a sample facility lease agreement to: K&K Insurance Group Tenant User Liability Program 1712 Magnavox Way Fort Wayne, IN Phone Fax: If all underwriting guidelines are met, a program proposal and quote will be provided. 4. You will be notified by K&K if, for any reason, your submission to this insurance is declined or determined to be ineligible for coverage. This brochure is for illustrative purposes only, and is not a contract of insurance. You must refer to the actual policy for complete information regarding coverage terms, conditions, and exclusions. You may request a copy of the full policy by submitting a written request to K&K Insurance Group. Page 3

4 1712 Magnavox Way P.O. Box 2338 Fort Wayne, IN (800) Fax: (260) CA# Name of Applicant: 2. Mailing Address: 3. Venue Name & Address: 4. Contact: Phone: 5. Venue Description: a. Year Built: b. Construction: c. Fire Protection: d. Permanent Seating Capacity: e. Temporary Seating Capacity: f. Security Program: g. Concessionaire: Estimated Actual Current Year Last Year 6. Total Number of Events Annually: 7. Number of Events Leased with Certificates of Insurance: 8. Number of Events Leased without Certificates of Insurance: 9. Who is responsible for the following (check one)? TENANT USER LIABILITY INSURANCE PROGRAM APPLICATION FOR FACILITIES Facility Tenant Subcontracted Other Parking Ticket Sales Security Maintenance Concession Sales First Aid (Personnel) 10. Are Certificates of Insurance obtained from those services that are subcontracted? Yes No 11. Are all parking lots well lit? Yes No 12. Are areas patrolled? Yes No 13. How long has the current management been at this facility? 14. Is there an emergency evacuation plan established for the facility? If yes, please attach a copy. Yes No 15. Do areas listed below meet local/county/state safety codes? Yes No 16. First aid facilities maintained? Yes No 17. Attending medical professional available? Yes No 18. Response time of nearest ambulance: Minutes. 19. Provide a list of events that have occurred during the past 12 months. 20. Provide a list of events scheduled in the next 12 months. 21. Provide Prior Loss History/Company Loss Runs. 22. Provide Facility Brochure/Literature. 23. Provide copy of sample facility lease agreement. Page 4

5 INSURANCE AGENT INFORMATION To be completed by the licensed agent representing the insured, if any. Agency Name: Agency Mailing Address: City: State: Zip: Agent/Contact Name: Agency Telephone: ( ) Agency Fax: ( ) Do you have existing business with K&K Insurance? Yes No For additional information regarding other programs, log on to our web site at Note to agents and brokers: Unless specifically granted by K&K in writing, agents do not have authority to issue binders or certificates of insurance on behalf of this program. Mailing Instructions Remit the completed and signed application form, list of events, prior loss history, facility brochure, and sample facility lease agreement to: K&K Insurance Group Tenant User Liability Program 1712 Magnavox Way Fort Wayne, IN Phone Fax: Page 5

Gallagher Public Entity & Scholastic Division National Tenant User Liability Program

Gallagher Public Entity & Scholastic Division National Tenant User Liability Program Gallagher Public Entity & Scholastic Division National Tenant User Liability Program Tenant Users Liability Insurance Policy (TULIP) Master General Liability Policy for Facilities/Venues Covering Special

More information

CITY AND COUNTY OF DENVER

CITY AND COUNTY OF DENVER Authority: Purpose of Ordinance: CITY AND COUNTY OF DENVER DEPARTMENT OF PUBLIC WORKS Public Works Permit Operations Development Engineering Services 2000 W. 3 rd Avenue, Room 107 Denver, Colorado 80223-1027

More information

SELIP Insurance Program Special Event Liability Insurance Program. County of Los Angeles

SELIP Insurance Program Special Event Liability Insurance Program. County of Los Angeles SELIP Insurance Program Special Event Liability Insurance Program SPECIAL EVENTS LIABILITY INSURANCE PROGRAM PROVIDING: COMMERCIAL GENERAL LIABILITY $1,000,000 PER OCCURENCE / $1,000,000 GENERAL AGGREGATE

More information

SELIP Insurance Program Special Event Liability Insurance Program. City of Los Angeles

SELIP Insurance Program Special Event Liability Insurance Program. City of Los Angeles SELIP Insurance Program Special Event Liability Insurance Program SPECIAL EVENTS LIABILITY INSURANCE PROGRAM PROVIDING: COMMERCIAL GENERAL LIABILITY $1,000,000 PER OCCURENCE / UNLIMTED GENERAL AGGREGATE

More information

TENANT USER LIABILITY INSURANCE PROGRAM (TULIP) FACILITY UNDERWRITING QUESTIONNAIRE

TENANT USER LIABILITY INSURANCE PROGRAM (TULIP) FACILITY UNDERWRITING QUESTIONNAIRE TENANT USER LIABILITY INSURANCE PROGRAM (TULIP) FACILITY UNDERWRITING QUESTIONNAIRE PROGRAM DESCRIPTION This insurance program has been designed for owners of U.S. based premises/facilities that are rented

More information

Address. Applicant is: Individual Corporation Partnership Joint Venture LLC Other

Address. Applicant is: Individual Corporation Partnership Joint Venture LLC Other Applicant s Name Agent Name Address Mailing Address Web Address Proposed Effective Date: From To (12:01 am Standard Time at the address of the Applicant) Applicant is: Individual Corporation Partnership

More information

Guidelines for the Special Events Insurance Program

Guidelines for the Special Events Insurance Program To: From: All Parishes, Schools and Diocesan Locations Bill Doran Risk Management Department Date: March 3, 2015 Re: Guidelines for the Special Events Insurance Program Our Carrier for the Special Events

More information

Tenant Users Liability Insurance Protection (TULIP)

Tenant Users Liability Insurance Protection (TULIP) Tenant Users Liability Insurance Protection (TULIP) The University of Texas at Dallas Adapted from information provided by The University of Texas System - Office of Risk Management Welcome This presentation

More information

The applicant declares that the information contained in this application is true and that no material facts have been suppressed or misstated.

The applicant declares that the information contained in this application is true and that no material facts have been suppressed or misstated. CLEAR RISK SOLUTIONS SPECIAL EVENT LIABILITY PROGRAM EVENT APPLICATION General Liability Aggregate Limit, $2 Million. THIS IS NOT A BINDER. INCOMPLETE AND UNSIGNED FORMS WILL BE RETURNED FOR COMPLETION.

More information

Special Events Liability Insurance. Optional Liquor Liability Coverage Available

Special Events Liability Insurance. Optional Liquor Liability Coverage Available Special Events Liability Insurance Optional Liquor Liability Coverage Available 4-H Clubs Antique Shows Auctions Banquets Bazaars Beauty Contests Cave Exploration Consumer Shows Contests Demolition Derbies

More information

Insurance Program and Enrollment Form This brochure is valid for effective dates from 2/1/11 through 1/31/12

Insurance Program and Enrollment Form This brochure is valid for effective dates from 2/1/11 through 1/31/12 CONCESSIONAIRES, EXHIBITORS & VENDORS Insurance Program and Enrollment Form This brochure is valid for effective dates from 2/1/11 through 1/31/12 PROGRAM DESCRIPTION This program has been designed for

More information

Special Events Liability

Special Events Liability Special Events Liability and Student Clubs Insurance The California State University Systemwide Risk Management Fitting the Pieces Together November 6, 2006 Hilton Arden West, Sacramento CSURMA California

More information

URMIA TULIP Program Tenant User Liability Insurance Policy

URMIA TULIP Program Tenant User Liability Insurance Policy URMIA TULIP Program Tenant User Liability Insurance Policy The TULIP Program is designed to provide low cost general liability insurance to third party users of Skidmore College facilities. It protects

More information

SAMPLE. Commercial Liability Coverage Part $506.00 Liquor Liability Coverage Part $45.00. See Endorsement EOD (1/95)

SAMPLE. Commercial Liability Coverage Part $506.00 Liquor Liability Coverage Part $45.00. See Endorsement EOD (1/95) NEW Renewal of Number POLICY DECLARATIONS No. CL 1717481 NAMED INSURED AND ADDRESS: Test 123 Main Street New York, NY 10001 United States Liability Insurance Company 1190 Devon Park Drive, Wayne, Pennsylvania

More information

American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016

American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016 American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016 This insurance program is available for amateur teams & leagues that are members

More information

INDEPENDENT INSTRUCTOR OF THE ARTS Insurance Program and Enrollment Form This brochure is valid for effective dates from 4/1/14 through 3/31/15

INDEPENDENT INSTRUCTOR OF THE ARTS Insurance Program and Enrollment Form This brochure is valid for effective dates from 4/1/14 through 3/31/15 INDEPENDENT INSTRUCTOR OF THE ARTS Insurance Program and Enrollment Form This brochure is valid for effective dates from 4/1/14 through 3/31/15 PROGRAM DESCRIPTION This program has been designed to meet

More information

Insurance Program and Enrollment Form This brochure is valid for effective dates from 1/1/14 through 12/31/14

Insurance Program and Enrollment Form This brochure is valid for effective dates from 1/1/14 through 12/31/14 VIRGO PUBLISHING TRADE SHOW & CONSUMER SHOW EXHIBITORS Insurance Program and Enrollment Form This brochure is valid for effective dates from 1/1/14 through 12/31/14 PROGRAM DESCRIPTION This program has

More information

SPECIAL EVENT LIABILITY APPLICATION

SPECIAL EVENT LIABILITY APPLICATION eventliability@hcc.com www.hccspecialty.com SPECIAL EVENT LIABILITY APPLICATION A. INSURED INFORMATION 1. Insured Company Name (Applicant): 2. Contact Name: 3. Address: 4. City: State: Zip Code: 5. Phone:

More information

GENERAL LIABILITY TULIP BINDER

GENERAL LIABILITY TULIP BINDER OneBeacon Entertainment Los Angeles New York 1100 Glendon Avenue Suite 900 77 Water Street, 17 th Floor Los Angeles, CA 90024 New York, NY 10005 CA License No. 0773887 Tel 212.440.6581 Tel 781.332.8400

More information

TEXAS HOME SCHOOL COALITION

TEXAS HOME SCHOOL COALITION TEXAS HOME SCHOOL COALITION Accident Medical and General Liability Insurance Program Exclusively Designed for Home School Groups and Organizations Affiliated with THSC Covering Students, Sports, Activities

More information

CHAPTER AND DISTRICT INSURANCE PROGRAM COVERAGE BARBERSHOP HARMONY SOCIETY POLICY PERIOD 1/1/15 TO 1/1/16

CHAPTER AND DISTRICT INSURANCE PROGRAM COVERAGE BARBERSHOP HARMONY SOCIETY POLICY PERIOD 1/1/15 TO 1/1/16 CHAPTER AND DISTRICT INSURANCE PROGRAM COVERAGE BARBERSHOP HARMONY SOCIETY POLICY PERIOD 1/1/15 TO 1/1/16 Chapter and District Insurance Program Coverage Barbershop Harmony Society Policy Period: 01/01/15

More information

DIRECTORS AND OFFICERS including Employment Practices Liability Insurance Application Rates available through 2/29/16

DIRECTORS AND OFFICERS including Employment Practices Liability Insurance Application Rates available through 2/29/16 1712 Magnavox Way P.O. Box 2338 Fort Wayne, IN 46801-2338 1-877-783-1161 Fax 1-260-459-5870 www.kandkinsurance.com DIRECTORS AND OFFICERS including Employment Practices Liability Insurance Application

More information

- Exit and entrance monitoring: - Policy regarding removal of liquor from the fenced area: - Policy regarding the checking of ID:

- Exit and entrance monitoring: - Policy regarding removal of liquor from the fenced area: - Policy regarding the checking of ID: 1. Name of Broker: 2. Phone Number: Fax Number: 3. Name of Insured: Contact Person: Title: Phone Number: 4. Mailing Address: 5. Name of Event: 6. Location of Event: 7. Description of Event: Please provide

More information

Insurance Program and Enrollment Form This brochure is valid for effective dates from 2/1/10 through 1/31/11

Insurance Program and Enrollment Form This brochure is valid for effective dates from 2/1/10 through 1/31/11 CONCESSIONAIRES, EXHIBITORS & VENDORS Insurance Program and Enrollment Fm This brochure is valid f effective dates from 2/1/10 through 1/31/11 PROGRAM DESCRIPTION This program has been designed f the concessionaires,

More information

K&K ICEL PLAN LIABILITY INSURANCE INDEPENDENT CLUB EVENT LIABILITY FOR RALLIES AUTOCROSS MARQUE CLUBS

K&K ICEL PLAN LIABILITY INSURANCE INDEPENDENT CLUB EVENT LIABILITY FOR RALLIES AUTOCROSS MARQUE CLUBS K&K ICEL PLAN LIABILITY INSURANCE INDEPENDENT CLUB EVENT LIABILITY FOR RALLIES AUTOCROSS MARQUE CLUBS Through its insurers, K&K Insurance Group, Inc., is pleased to offer this package of much needed coverages

More information

Special Event Liability Application

Special Event Liability Application HCC Specialty 401 Edgewater Place, Suite 400 Wakefield, MA 01880 main (781) 994 6000 facsimile (781) 994 6001 e-mail: eventliability@hcc.com Special Event Liability Application A. INSURED INFORMATION 1.

More information

Protecting Your Club While Growing The Pride June 29, 2015 Presented By: John E. Adams

Protecting Your Club While Growing The Pride June 29, 2015 Presented By: John E. Adams The International Association of Lions Clubs Liability Insurance Plan Protecting Your Club While Growing The Pride June 29, 2015 Presented By: John E. Adams Program Outline Overview of the Liability Plan

More information

USATRACK&FIELD GENERAL LIABILITY INSURANCE. USA TRACK & FIELD GENERAL LIABILITY SUMMARY OF INSURANCE EFFECTIVE 11/1/2012-11/1/2013 (REV.

USATRACK&FIELD GENERAL LIABILITY INSURANCE. USA TRACK & FIELD GENERAL LIABILITY SUMMARY OF INSURANCE EFFECTIVE 11/1/2012-11/1/2013 (REV. USATRACK&FIELD GENERAL LIABILITY INSURANCE USA TRACK & FIELD GENERAL LIABILITY SUMMARY OF INSURANCE EFFECTIVE 11/1/2012-11/1/2013 (REV. Feb 2013) NAMED INSUREDS: The following parties are included as Named

More information

Special Events Insurance Keeping the Grinch Away! Chief Business Officials December 13, 2012

Special Events Insurance Keeping the Grinch Away! Chief Business Officials December 13, 2012 Special Events Insurance Keeping the Grinch Away! Chief Business Officials December 13, 2012 1 What is special events insurance? Why would the school district need special events insurance? When should

More information

Insurance Program. For the State of Georgia

Insurance Program. For the State of Georgia Insurance Program For the State of Georgia Presented By: RC KNOX & COMPANY ONE GOODWIN SQUARE HARTFORD, CT 06103 (860) 524-7614 APRIL 21, 2009 QUOTATION PROGRAM INSURER: INSURANCE AGENCY: POLICYHOLDER:

More information

Insurance Program and Enrollment Form

Insurance Program and Enrollment Form MOTORSPORTS INDEPENDENT CLUB EVENT LIABILITY Insurance Program and Enrollment Form PROGRAM DESCRIPTION This program has been designed for U.S.-based Car Clubs. We offer affordable general liability protection

More information

PERSONAL UMBRELLA. ADMITTED in AK, CA, ID, OR. Superior Underwriters Primex Insurance Brokers A.M. BEST A+XV RATED CARRIER

PERSONAL UMBRELLA. ADMITTED in AK, CA, ID, OR. Superior Underwriters Primex Insurance Brokers A.M. BEST A+XV RATED CARRIER ADMITTED in AK, CA, ID, OR PERSONAL UMBRELLA LIABILITY A standalone personal umbrella product that specializes in providing a market for hard to place risks. Four distinct lines available: Primary Umbrella

More information

OFF-ROAD CLUB EVENT LIABILITY INSURANCE COVERAGE

OFF-ROAD CLUB EVENT LIABILITY INSURANCE COVERAGE OFF-ROAD CLUB EVENT LIABILITY INSURANCE COVERAGE Coverage Information General Liability Coverage for Car Club Social Events We offer affordable general liability protection for limits of $1 million for

More information

PREPARED BY: 2560 RIVER PARK PLAZA, SUITE 300 FORT WORTH, TEXAS (866) 738-6100 PULLENINS.COM

PREPARED BY: 2560 RIVER PARK PLAZA, SUITE 300 FORT WORTH, TEXAS (866) 738-6100 PULLENINS.COM WYOMING YOUTH SOCCER 2013 / 2014 INSURANCE PROPOSAL PREPARED BY: 2560 RIVER PARK PLAZA, SUITE 300 FORT WORTH, TEXAS (866) 738-6100 PULLENINS.COM 2013 / 2014 Coverage Highlights Summary Player Medical and

More information

NORTH EAST FLORIDA EDUCATIONAL CONSORTIUM RISK MANAGEMENT PROGRAM FACILITIES USE/SPECIAL EVENTS LIABILITY COVERAGE PURPOSE

NORTH EAST FLORIDA EDUCATIONAL CONSORTIUM RISK MANAGEMENT PROGRAM FACILITIES USE/SPECIAL EVENTS LIABILITY COVERAGE PURPOSE NORTH EAST FLORIDA EDUCATIONAL CONSORTIUM RISK MANAGEMENT PROGRAM FACILITIES USE/SPECIAL EVENTS LIABILITY COVERAGE PURPOSE Make school district facilities available to community groups and organizations

More information

* Order your shoulder emblems at the same time of original charter and save on shipping! Emblems will ship via UPS to the league president along with

* Order your shoulder emblems at the same time of original charter and save on shipping! Emblems will ship via UPS to the league president along with * Order your shoulder emblems at the same time of original charter and save on shipping! Emblems will ship via UPS to the league president along with the league kit supplies, rule books & scorebooks. Chartering/insurance

More information

USATRACK&FIELD. General Liability Insurance Program

USATRACK&FIELD. General Liability Insurance Program USATRACK&FIELD General Liability Insurance Program This brochure has been prepared for USA Track & Field (USATF) for the exclusive use by its members. Its purpose is to describe and explain, in a summary

More information

Special Event General Liability Application

Special Event General Liability Application Scottsdale Insurance Company Home Office: One Nationwide Plaza Columbus, Ohio 43215 Adm. Office: 8877 North Gainey Center Drive Scottsdale, Arizona 85258 Scottsdale Indemnity Company Home Office: One Nationwide

More information

2015 PLUMAS-SIERRA COUNTY FAIR APPLICATION August 12-16, 2015 204 Fairgrounds Road -- Quincy, CA 95971 Phone: (530) 283-6272 Fax: (530) 283-6431

2015 PLUMAS-SIERRA COUNTY FAIR APPLICATION August 12-16, 2015 204 Fairgrounds Road -- Quincy, CA 95971 Phone: (530) 283-6272 Fax: (530) 283-6431 2015 PLUMAS-SIERRA COUNTY FAIR APPLICATION August 12-16, 2015 204 Fairgrounds Road -- Quincy, CA 95971 Phone: (530) 283-6272 Fax: (530) 283-6431 Check One: Commercial Vendor Exhibitor Food Concession Game

More information

Special Event General Liability Application

Special Event General Liability Application Special Event General Liability Application Applicant s Name: Agency Name: Agent: Mailing Address: Address: Website Address: E-mail: Phone: PROPOSED EFFECTIVE DATE: From To 12:01 A.M., Standard Time at

More information

Frequently Asked Questions

Frequently Asked Questions Overview of NICA Insurance Policy National Interscholastic Cycling Association 2414 Sixth Street Berkeley CA 94710 (510) 524-5464 www.nationalmtb.org Clubs: General Liability (Includes coverage for Trail

More information

Special Event Supplemental General Liability Application

Special Event Supplemental General Liability Application Scottsdale Insurance Company Home Office: One Nationwide Plaza Columbus, Ohio 43215 Adm. Office: 8877 North Gainey Center Drive Scottsdale, Arizona 85258 Scottsdale Indemnity Company Home Office: One Nationwide

More information

SPECIAL EVENT LIABILITY APPLICATION. 1. Insured Company Name (Applicant): 2. Contact Name: 3. Address: 4. City: State: Zip Code:

SPECIAL EVENT LIABILITY APPLICATION. 1. Insured Company Name (Applicant): 2. Contact Name: 3. Address: 4. City: State: Zip Code: HCC SPECIALTY UNDERWRITERS, INC. A SUBSIDIARY OF HCC INSURANCE HOLDINGS, INC. 401 Edgewater Place, Suite 400, Wakefield, Massachusetts 01880 Telephone: (781) 994-6000 Facsimile: (781) 994-6001 www.hccsu.com

More information

EVENT PLANNER Insurance Program and Enrollment Form This brochure is valid for effective dates from 12/1/13 through 3/31/15

EVENT PLANNER Insurance Program and Enrollment Form This brochure is valid for effective dates from 12/1/13 through 3/31/15 EVENT PLANNER Insurance Program and Enrollment Form This brochure is valid for effective dates from 12/1/13 through 3/31/15 Sexual Abuse/Molestation Liability Now Available Higher liability limit options

More information

RPG DIRECTORS & OFFICERS LIABILITY

RPG DIRECTORS & OFFICERS LIABILITY RPG DIRECTORS & OFFICERS LIABILITY including Employment Practices Liability for Not-for-Profit Organizations (Claims-made Coverage) Insurance Program and Enrollment Form This brochure is valid for effective

More information

FACILITY USER ACTIVITY/RATING GUIDE- As at October 25, 2015

FACILITY USER ACTIVITY/RATING GUIDE- As at October 25, 2015 FACILITY USER ACTIVITY/RATING GUIDE- As at October 25, 2015 NOTE: At the time of renting a facility or taking out a permit, the rate (which includes provincial sales tax), will be added to your rental

More information

Overview of NICA Insurance Policy

Overview of NICA Insurance Policy Overview of NICA Insurance Policy Clubs: General Liability (includes coverage for trail maintenance and repair by the club. Club rides, training rides/races and other club functions such as meetings and

More information

USA Swimming, Inc. Local Swimming Committees

USA Swimming, Inc. Local Swimming Committees 2015 INSURANCE SUMMARY for USA Swimming, Inc. Local Swimming Committees Presented By: John E. Peterson, CPCU, ARM, CIC President RISK MANAGEMENT SERVICES, INC. PO Box 32712 Phoenix, Arizona 85064-2712

More information

HAUNTED HOUSE INSURANCE APPLICATION GENERAL INFORMATION

HAUNTED HOUSE INSURANCE APPLICATION GENERAL INFORMATION HAUNTED HOUSE INSURANCE APPLICATION GENERAL INFORMATION 1. Named Insured (Applicant): 2. a. Address: City: State: Zip: b. Describe Applicant s role & responsibility in event: 3. Phone: Fax: E-mail: 4.

More information

Submissions: quotes@firestoneagency.com ACORD Applications

Submissions: quotes@firestoneagency.com ACORD Applications Insurance Underwriters Excess & Surplus Lines Brokers MGA 1500 University Drive, Suite #212, Coral Springs FL 33071 954.341.8331; 1.800.683.1150; Fax: 954.345.7620 www.firestoneagency.com Submissions:

More information

By a program of COMPREHENSIVE GENERAL LIABILITY INSURANCE

By a program of COMPREHENSIVE GENERAL LIABILITY INSURANCE By a program of COMPREHENSIVE GENERAL LIABILITY INSURANCE For KIWANIS INTERNATIONAL and its member clubs, divisions and districts GENERAL In the UNITED STATES AND CANADA, Kiwanis International has a program

More information

Security Guards and Related Operations General Liability Application

Security Guards and Related Operations General Liability Application 8877 North Gainey Center Drive Scottsdale, Arizona 85258 1-800-423-7675 Fax (480) 483-6752 www.scottsdaleins.com Security Guards and Related Operations General Liability Application Applicant s Name Mailing

More information

Babe Ruth League Chartering & Insurance A Step-by-Step Guide

Babe Ruth League Chartering & Insurance A Step-by-Step Guide Babe Ruth League Chartering & Insurance A Step-by-Step Guide * New for 2012: Order your shoulder emblems at the same time of original charter and save on shipping! Emblems will ship via UPS to the league

More information

James River Insurance Company and its Subsidiaries. 6641 West Broad Street, Suite 300 Richmond, VA 23230

James River Insurance Company and its Subsidiaries. 6641 West Broad Street, Suite 300 Richmond, VA 23230 James River Insurance Company and its Subsidiaries 6641 West Broad Street, Suite 300 Richmond, VA 23230 Special Event Application SPORTS & ENTERTAINMENT Division Email to SE@jamesriverins.com or, Fax to

More information

Festival & Event Planning

Festival & Event Planning Festival & Event Planning Developing an Auction Dinner EVENT DEVELOPMENT SERIES Module Two Event Planning Manual 2008 Gary McWilliams Developing an Auction Dinner Volunteers Make It Happen! I have had

More information

MUNICIPAL JOINT INSURANCE FUND

MUNICIPAL JOINT INSURANCE FUND MUNICIPAL JOINT INSURANCE FUND Guidelines for Certificates of Insurance, Additional Insured Requirements & Hold Harmless Agreements f:d/w/r/municipal/reports/coinew1.doc TABLE OF CONTENTS INTRODUCTION...

More information

Risk Management Department

Risk Management Department Risk Management Department Special Events Insurance Chapman University requires liability insurance for vendors, performers, and exhibitors (parties) who participate in special events on campus, and from

More information

Apply Online for INSTANT Proof of Coverage www.sadlersports.com/personaltrainerinsurance

Apply Online for INSTANT Proof of Coverage www.sadlersports.com/personaltrainerinsurance P. O. Box 5866, Columbia, SC 29250-5866 Phone: (800) 622-7370, Fax: (803) 256-4017 Email: instructor@sadlersports.com Fitness Instructor Insurance Program and Enrollment Form This brochure is valid for

More information

M UNICIPAL J OINT I NSURANCE F UND

M UNICIPAL J OINT I NSURANCE F UND M UNICIPAL J OINT I NSURANCE F UND Guidelines for Certificates of Insurance, Additional Insured Requirements & Hold Harmless Agreements Revised January, 2006 TABLE OF CONTENTS INTRODUCTION... ii Certificates

More information

COMMERCIAL LIABILITY INSURANCE APPLICATION

COMMERCIAL LIABILITY INSURANCE APPLICATION 5800 Explorer Drive, Suite 310 Mississauga, ON L4W 5K9 905-602-9339 or 800-753-2632 Fax: 905-602-9141 www.kandkcanada.com K&K Insurance Brokers, Inc. Canada COMMERCIAL LIABILITY INSURANCE APPLICATION 1.

More information

Insurance. Not-for-profit Organisations Public and Products Liability Insurance Application Form

Insurance. Not-for-profit Organisations Public and Products Liability Insurance Application Form Insurance Not-for-profit Organisations Public and Products Liability Insurance Application Form Important Notices It is very important that You read the information below and are satisfied You understand

More information

COUNTY INSURANCE & INDEMNIFICATION. SPARTA: Contractors Liability Insurance Program INSURANCE PROGRAMS

COUNTY INSURANCE & INDEMNIFICATION. SPARTA: Contractors Liability Insurance Program INSURANCE PROGRAMS COUNTY INSURANCE & INDEMNIFICATION INSURANCE PROGRAMS The County uses a variety of methods to handle its risk exposures and control its Cost of Risk. For example, some risk exposures are retained by the

More information

Youth Sports Camp & Clinic Insurance Program

Youth Sports Camp & Clinic Insurance Program Youth Sports Camp & Clinic Insurance Program Rates and Limits Effective 3/1/2011-2/29/2012 PROGRAM DESCRIPTION This program has been designed for U.S.-based youth sports camp operations (those attended

More information

ENTERTAINMENT & EVENTS LIABILITY INSURANCE

ENTERTAINMENT & EVENTS LIABILITY INSURANCE Arena Underwriting Pty Ltd ABN: 26 125 869 481 AFS: 317617 Suite 8, 12 Alma Road, New Lambton NSW 2305 Tel: 02 4952 4477 Fax: 02 4915 5376 www.arenaunderwriting.com.au ENTERTAINMENT & EVENTS LIABILITY

More information

Greenwich Insurance Company (American Specialty) - General Liability National Union Fire Insurance Company Sport Accident

Greenwich Insurance Company (American Specialty) - General Liability National Union Fire Insurance Company Sport Accident II. INSURANCE RECAP Entertainment & Sports Insurance Experts, Inc. 2727 Paces Ferry Road Building Two, Suite 1500 Atlanta, GA 30339 Phone: 678-324-3300 Fax: 678-324-3303 # # # #!$%&'(&)&*&)+,+-& (.&/0*0/01(2)'1/&/,1+)'/+(*,)3&+'0%(,1/,4&)'5&6/,130+0,1('13&7/%2(0,1(8!

More information

Special Event Application

Special Event Application 1/7 Special Event Application Please note: Questions marked in bold are required. Complete the application as fully as possible to ensure an accurate quote. If you have any questions please contact our

More information

Community Service Insurance Program

Community Service Insurance Program Community Service Insurance Program Patriot Insurance Agency, Inc. DBA: Arizona Patriot Insurance Agency, Inc. in CA, NC, ND P.O. Box 1298 Sonoita, AZ 85637-1298 Phone: 520 455-9252 Fax: 520 455-9358 Toll

More information

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage-

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage- Amateur Sports Team & League Liability Insurance Application -No Participant Coverage- Name of Organization: C/O (Individual Responsible for Insurance): Mailing : City: State: Zip: Phone: ( ) Fax: ( )

More information

KISSIMMEE PARKS, RECREATION & PUBLIC FACILITIES LAKEFRONT PARK PUBLIC EVENT RESERVATION APPLICATION

KISSIMMEE PARKS, RECREATION & PUBLIC FACILITIES LAKEFRONT PARK PUBLIC EVENT RESERVATION APPLICATION KISSIMMEE PARKS, RECREATION & PUBLIC FACILITIES LAKEFRONT PARK PUBLIC EVENT RESERVATION APPLICATION IMPORTANT: Please type or print legibly. All sections must be completed. Reservation deposits are Non

More information

FOUR EASY WAYS TO ENROLL FOR COVERAGE ELIGIBLE OPERATIONS PROGRAM DESCRIPTION INELIGIBLE OPERATIONS

FOUR EASY WAYS TO ENROLL FOR COVERAGE ELIGIBLE OPERATIONS PROGRAM DESCRIPTION INELIGIBLE OPERATIONS EXERCISE/CIRCUIT/PERSONAL TRAINING STUDIO Insurance Program and Enrollment Form This brochure is valid for effective dates from 1/1/15 through 12/31/15 PROGRAM DESCRIPTION This program has been designed

More information

CONTRACTORS APPLICATION

CONTRACTORS APPLICATION CONTACT: E-MAIL ADDRESS: FOR COMPANY USE ONLY CONTRACTORS PRODUCER TELEPHONE: FAX: SUB- PRODUCER TELEPHONE: FAX: NAME: NAME: ADDRESS: ADDRESS: CITY: CITY: STATE: ZIP CODE: STATE: ZIP CODE: PROPOSED EFFECTIVE

More information

GENERAL INFORMATION - LIABILITY INSURANCE DISCOVERY QUESTIONNAIRE THIS IS FOR QUOTATION PURPOSES ONLY THIS IS NOT A BINDER

GENERAL INFORMATION - LIABILITY INSURANCE DISCOVERY QUESTIONNAIRE THIS IS FOR QUOTATION PURPOSES ONLY THIS IS NOT A BINDER ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON, FILES AN APPLICATION FOR INSURANCE CONTAINING ANY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING,

More information

CITY OF FLAGSTAFF SPECIAL EVENT APPLICATION

CITY OF FLAGSTAFF SPECIAL EVENT APPLICATION CITY OF FLAGSTAFF SPECIAL EVENT APPLICATION INTRODUCTION Any organized activity involving the use of, or having impact upon, City property, City facilities, parks, sidewalks, street areas or the temporary

More information

(to be shown on policy declarations page) City State Zip

(to be shown on policy declarations page) City State Zip Clubs/Groups & Special Event Insurance Request for Quote Instructions to obtain a Quote: 1. Complete form entirely to receive a quote. If the form is not completed, additional information will have to

More information

USA Volleyball, United States Volleyball Association, United States Volleyball, Inc. ( USAV ), USA Volleyball Foundation

USA Volleyball, United States Volleyball Association, United States Volleyball, Inc. ( USAV ), USA Volleyball Foundation INSURANCE PROGRAM USA Volleyball administers a medical and liability insurance program customized specifically for the sport of volleyball. It is designed to respond specifically to the inherent hazards

More information

National Baseball Congress 2016 General Liability and Accident Insurance Program

National Baseball Congress 2016 General Liability and Accident Insurance Program National Baseball Congress 2016 General Liability and Accident Insurance Program About NBC Team Insurance Since 1931, the National Baseball Congress has thrilled baseball fans throughout the United States

More information

USA Swimming 2014 Insurance Summary

USA Swimming 2014 Insurance Summary USA Swimming 2014 Insurance Summary Table of Contents Page Membership Protection...2 Excess Accident Medical Insurance...2 Liability Insurance Program...3 A. General Liability...3 Coverage & Limits of

More information

AMERICAN FEDERATION OF MUSICIANS Musicians Liability Insurance Plan. providing up to $2,000,000 aggregate coverage each year!

AMERICAN FEDERATION OF MUSICIANS Musicians Liability Insurance Plan. providing up to $2,000,000 aggregate coverage each year! AMERICAN FEDERATION OF MUSICIANS Musicians Liability Insurance Plan. providing up to $2,000,000 aggregate coverage each year! THE SOLUTION FOR MUSICIANS LIABILITY PROBLEMS Many facilities now require musicians

More information

Ice Rink Application For General Liability Insurance

Ice Rink Application For General Liability Insurance Ice Rink Application For General Liability Insurance General Information Proposed Effective Date Rink name (DBA) Corporate name: Mailing address: (Street) (City) (State) (Zip) Location address (if different):

More information

MARINE COMMERCIAL LIABILITY POLICY APPLICATION

MARINE COMMERCIAL LIABILITY POLICY APPLICATION Page 1 of 5 MARINE COMMERCIAL LIABILITY POLICY APPLICATION A. GENERAL INFORMATION DATE A. Account Name Address: City / State / Country: Website: B. Insurance Agent or Broker: Address: City / State / Country:

More information

SRIM Airmeet Liability Form. Airmeet/Balloon Event Fly-In Static Display. Name Insured: (Exact name of organization to be insured (principal sponsor))

SRIM Airmeet Liability Form. Airmeet/Balloon Event Fly-In Static Display. Name Insured: (Exact name of organization to be insured (principal sponsor)) SRIM Airmeet Liability Form Airmeet/Balloon Event Fly-In Static Display Name Insured: (Exact name of organization to be insured (principal sponsor)) Mailing Address: Name of Event: Name and location of

More information

SPECIAL EVENT APPLICATION

SPECIAL EVENT APPLICATION SPECIAL EVENT APPLICATION Office of Special Events 8401 W. Monroe Street Peoria, AZ 85345 Phone: (623) 773-7564 Fax: (623) 773-7118 OFFICE USE ONLY Date Rec d. Initials Number Please complete all information,

More information

SPECIAL EVENT PERMIT APPLICATION

SPECIAL EVENT PERMIT APPLICATION SPECIAL EVENT PERMIT APPLICATION The organizer of a special event must fill out the application and return it to the City of Greenwood NO LESS THAN 30 BUSINESS DAYS PRIOR TO THE START OF THE EVENT. WHAT

More information

National Baseball Congress 2015 General Liability and Accident Insurance Program

National Baseball Congress 2015 General Liability and Accident Insurance Program National Baseball Congress 2015 General Liability and Accident Insurance Program About NBC Team Insurance Since 1931, the National Baseball Congress has thrilled baseball fans throughout the United States

More information

Application for Home, Auto, and Umbrella Coverage

Application for Home, Auto, and Umbrella Coverage Application for Home, Auto, and Umbrella Coverage Total Pages: 6 pages including cover page Thank you for requesting quotes for your Home, Auto, and Umbrella insurance from TDIC Insurance Solutions. Please

More information

Short Term Productions Application

Short Term Productions Application About This Program This application is used to insure a single production with a maximum budget of $1,000,000 and a maximum duration of 60 days within a 60 day consecutive period. Required Documents The

More information

APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK GENERAL EVENT INFORMATION. / / End Date: / /

APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK GENERAL EVENT INFORMATION. / / End Date: / / Official Name of Special Event: GENERAL EVENT INFORMATION Start Date: / / End Date: / / Briefly describe your event. Be sure to include the purpose of the event and a description of all planned activities.

More information

Commercial Liability Insurance Application

Commercial Liability Insurance Application Commercial Liability Insurance Application Name of Applicant: Address: Applicant s Trade or Business: Name, Address & Trade or Business of all Subsidiary Companies: How long has Applicant been in business?

More information

Amateur Sports Insurance Application Leagues / Camps / Clinics

Amateur Sports Insurance Application Leagues / Camps / Clinics www.markelah.com Return Completed form to: P.O. Box 2009, Glen Allen, Virginia 23058-2009 P: 800-431-1270 F: 804-527-7915 Amateur Sports Insurance Application Leagues / Camps / Clinics Date Completed /

More information

Auto Repair and Service Insurance Application

Auto Repair and Service Insurance Application Auto Repair and Service Insurance Application INSTRUCTIONS: ALL QUESTIONS MUST BE ANSWERED IN FULL. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED MVR S MUST BE SUBMITTED ON ALL OWNERS AND EMPLOYEES. Producer

More information

MUNICIPALITY OF THAMES CENTRE RECREATION. Facility User Group Liability Insurance Program

MUNICIPALITY OF THAMES CENTRE RECREATION. Facility User Group Liability Insurance Program MUNICIPALITY OF THAMES CENTRE COMMUNITY SERVICES & DEVELOPMENT RECREATION REPORT NO. PR- 026-14 TO: Mayor and Members of Council FROM: Liz Murray DATE: December 15, 2014 SUBJECT: Facility User Group Liability

More information

SUPPLEMENTAL APPLICATION Hotels & Resorts Insurance Program CITA Insurance Services A division of Brown & Brown Program Insurance Services, Inc.

SUPPLEMENTAL APPLICATION Hotels & Resorts Insurance Program CITA Insurance Services A division of Brown & Brown Program Insurance Services, Inc. SUPPLEMENTAL APPLICATION s & Resorts Insurance Program CITA Insurance Services A division of Brown & Brown Program Insurance Services, Inc. Instructions: A separate supplemental application is required

More information

Film Shoot Questionnaire for Permit (Please fill out and return to rbourestom@addisontx.gov) Production Company: Primary contact:

Film Shoot Questionnaire for Permit (Please fill out and return to rbourestom@addisontx.gov) Production Company: Primary contact: Film Shoot Questionnaire for Permit (Please fill out and return to rbourestom@addisontx.gov) Production Company: Primary contact: Company/address/phone/fax/email Purpose of shoot: Date/Time/Locations:

More information

NEW JERSEY RE-INSURANCE COMPANY UMBRELLA INSURANCE APPLICATION

NEW JERSEY RE-INSURANCE COMPANY UMBRELLA INSURANCE APPLICATION NEW JERSEY RE-INSURANCE COMPANY UMBRELLA INSURANCE APPLICATION Instructions for completing your Umbrella Insurance Application. We are pleased to provide you with the following Personal Umbrella Liability

More information

Insured Name is the Legal entity to be insured (e.g. ABC Pty Ltd, J & G Smith T/as, ABC Organising Committee, etc) Postal Address State Post Code

Insured Name is the Legal entity to be insured (e.g. ABC Pty Ltd, J & G Smith T/as, ABC Organising Committee, etc) Postal Address State Post Code Duty of Disclosure Before you enter into a contract of general or life insurance with an Underwriter you have a duty, under the Insurance Contracts Act, 1984, to disclose to the Underwriter every matter

More information

LOS ANGELES UNIFIED SCHOOL DISTRICT Division of Risk Management and Insurance Services

LOS ANGELES UNIFIED SCHOOL DISTRICT Division of Risk Management and Insurance Services LOS ANGELES UNIFIED SCHOOL DISTRICT Division of Risk Management and Insurance Services Insurance Services, Risk Finance & Liability Claims LAUSD INSURANCE GUIDELINES Please use this checklist as a guideline

More information

n Martial Arts Schools or Studios Martial Arts Accident & Liability Insurance

n Martial Arts Schools or Studios Martial Arts Accident & Liability Insurance n Martial Arts Schools or Studios Martial Arts Accident & Liability Insurance The Accident Coverage Who Is Covered All participants in the covered activity; including members, coaches, managers, or volunteers

More information

THE COSSIO INSURANCE AGENCY

THE COSSIO INSURANCE AGENCY Boxing, Kickboxing, Mixed Martial Arts, Wresting & Toughman Competitions Insurance THE COSSIO INSURANCE AGENCY Boxing, Kickboxing, Mixed Martial Arts, Wrestling & Toughman Competitions Insurance For many

More information

SUBCONTRACTOR PREQUALIFICATION FORM

SUBCONTRACTOR PREQUALIFICATION FORM SUBCONTRACTOR PREQUALIFICATION FORM Instructions: Please fill out the following information and return via email to info@norconinc.com or mail to Norcon, Inc. 661 W. Ohio Street, Chicago, IL 60654, Attention

More information