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Annual Theatrical/Musical Production Liability Application

Liability Coverage to Include Participant Third-Party Liability Claims


Event Location



Please fill out the following in regards to any other upcoming planned productions in the next year.




Accident medical coverage is required in order to place participant liability coverage

Volunteer Accident coverages available:
Eligibility: All Participants & Staff of the Policyholder.
Benefits
Up to $25,000.00 Maximum Medical Benefit per Claim
Up to $5,000.00 Accidental Death/Dismemberment
Dental Benefit: Included in Maximum Medical Benefit
Excess coverage will be offered on quote with a deductible.



Additional Insured

(Usually the facility hosting the event)

Fraud Warning

Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties, as well as the withdrawal of such insurance and/or the denial of any coverages and/or claims.



Broker Information (if applicable)

Event Insurance Now
Phone (877) 305-5040
Fax (503) 977-5648
events@eventinsurancenow.com