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California Events Only

LIABILITY INSURANCE COVERAGES
Coverage Amount Amount
General Aggregate $2,000,000 $4,000,000
Each Occurrence $1,000,000 $2,000,000
Products/Completed Operations Aggregate $1,000,000 $2,000,000
Personal & Advertising Injury $1,000,000 $2,000,000
Damage to Premises Rented to you $300,000 $300,000
Medical Expense Payments $5,000 $5,000
ATTENDANCE AND PREMIUMS (per event) (per event)
Attendance Premium * Premium *
1,500 OR LESS $383 $575
1,501 to 3,000 $740 $1,110
3,001 to 6,000 $1,479 $2,218
6,001 to 12,000 (maximum) $2,550 $3,825

* Premiums are based on a typical special event. Prices may vary depending on the desired coverage as indicated below.

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Customer Information
Eligible Event
Insured Name
Mailing Address
City
State
Zip Code
Contact Person
E-mail
Website
Home Phone
Work Phone
FAX

Event Information:
Name of Event:
Event Date(s) include set up and/or tear down days:
Time of Event From:
Time of Event To:
Location of Event:
Event to be held: Indoors Outdoors
Average age of Attendees:
Performers appearing at this event and type of music:
Estimated per day attendance:
Are overnight stay or camping accommodations provided by the event organizer? Yes No
Is alcohol being served? Yes No If yes, who holds the liquor license?
Is alcohol being sold? Yes No If yes, who holds the liquor license?
Crowd Control? Ushers Private Police Other:
Will Crowd Control be armed? Yes No N/A
Will this event feature any of the following? If selected, please describe in the detailed description area below.
Will bleachers, platforms or stages be used? Permanent Portable No
Is there an admission charge? Yes No If yes, ticket price. $
Is this event part of a larger event? Yes No If yes, please describe role and responsibility for the larger event in the detailed description area below.
Has this event been held before? Yes No
Was the event insured before? Yes No If yes, by who?
Were there any losses or claims on prior events? Yes No If Yes, please describe in the Detailed Description

Detailed description of event:

Eligible Additional Insureds:
Name & Address
of Additional Insured #1
Relationship? Owner / Lessor or premises Sponsor Co-promoter
Name & Address
of Additional Insured #2
Relationship? Owner / Lessor or premises Sponsor Co-promoter

Reporting Method
How would you like to receive
your free Special Events Insurance quote?		 U.S.Postal E-mail Fax

 

Home Page | E-Mail

 Gary Jones Insurance Agency  CA License #0E22842  insure@iinsureit.com
 508 Main Street  310-615-0940 Phone  888-MY-INS-GUY
 El Segundo, CA 90245  310-615-0994 Fax  888-694-6748