Special Event Liability Insurance Application

Name of Applicant / Organization *

Applicant's mailing address *

Applicant is: *

If Other, please explain (not required)

The applicant's role at this event is: *

If Other, describe the applicant's role (not required)

Applicant's interest in this event (not required)

Do you have coverage for this now? *

Yes No

Who is it with now? (not required)

When does that policy expire? (not required)

Names of other individuals or groups taking part in or sponsoring this event (not required)

Name of the event venue (not required)

Location where the event will take place *

The location is: (not required)

If Other, describe the location (not required)

The event is being held: *

Indoor Outdoor Both indoor and outdoor

Name of the event *

Type of event *

If Other, describe the event type (not required)

Full description of the event, schedule, and purpose *

Event website address (if any) (not required)

Is this part of a larger event? (not required)

Yes No

If yes, please describe the larger event (not required)

Event start date *

Event end date *

Event start time *

Event end time (if it runs past midnight, the time it actually ends) *

If the hours are different on any other day of the event, list them here (not required)

If multiple or recurring event dates, list them here (not required)

Are there separate set-up or take-down days before or after the event? (not required)

Yes No

Set-up start date (before the event) (not required)

Set-up end date (not required)

Take-down start date (after the event) (not required)

Take-down end date (not required)

Will heavy machinery (bulldozer, backhoe, excavator or similar industrial equipment) be used for set-up or take-down? Small forklifts and light machinery are fine. (not required)

Yes No

Rain date, if one is scheduled (not required)

Wedding: rehearsal date (not required)

Wedding: breakfast / brunch date (not required)

Coverage effective date (desired) *

Coverage expiration date (desired) (not required)

Is there an admission fee? *

Yes No

Price of admission (not required)

Estimated gross receipts (not required)

Admission is: (not required)

General Admission By invitation only

Total estimated attendees per day (not required)

If you are an individual exhibitor or vendor, estimated attendees visiting your booth per day (not required)

Total estimated attendees for the entire event *

Maximum capacity of the location holding the event (not required)

Average age of attendees (not required)

What type of seating will be provided? (check all that apply) (not required)

Is the seating temporary or permanent? (not required)

Temporary Permanent Not applicable

If temporary, who is responsible for set up? (not required)

Water hazards present at the location (check all that apply) (not required)

If Other water hazard, describe (not required)

Has this event taken place before? *

Yes No

How many years has it been held? (not required)

What was the previous attendance? (not required)

Has the applicant had previous insurance for this or a similar event? (not required)

Yes No

Prior carrier (not required)

Expiring premium (not required)

Prior policy number (not required)

Any losses in the past five years? (not required)

Yes No

If yes, describe the loss(es) (please also attach loss runs below) (not required)

The loss was under: (not required)

General liability Liquor liability

Date of loss (not required)

Claim status (not required)

Open Closed

Amount paid (not required)

Amount reserved (not required)

Limits of liability requested *

Name of any Additional Insured (e.g. venue, city, sponsor) (not required)

Additional Insured's mailing address (not required)

Additional Insured's interest in this event (not required)

Does the venue or contract require either of these? (check all that apply) (not required)

Primary and non-contributory Waiver of subrogation Neither / not sure

Will there be any live music? (not required)

Yes No

What type of music? (not required)

Name of entertainer / band (not required)

The performers are: (not required)

Local National

Any other type of entertainment? (not required)

Yes No

Describe the other entertainment (not required)

Any stage pyrotechnics? (not required)

Yes No

Stage pyrotechnics are: (not required)

Indoor Outdoor

Do you require all musicians/entertainers to provide a Certificate of Insurance? (not required)

Yes No

Describe any electrical or stage construction work performed by or for you (not required)

Describe the athletic event (not required)

Sporting event: number of participants (not required)

Participants are: (not required)

Professional Amateur

If professional, list the athletes (not required)

Age of participants: (not required)

Under 18 Over 18 Both

Is coverage desired for the participants? (not required)

Yes No

Describe distance and protection between spectators and participants (not required)

Is this an off-road, trail run, mud run or obstacle event? (not required)

Yes No

Political event scope: (not required)

National State Local

Name and title of the political figure (not required)

Car show: do the vehicles stay stationary throughout the show with their engines off? (not required)

Yes No

Car show: will the event feature burnouts, drag races or flame throwing? (not required)

Yes No

Race / rodeo: is the venue designed specifically for this type of activity? (not required)

Yes No

Race / rodeo: will there be barriers in place to protect spectators? (not required)

Yes No

Are the barriers metal or concrete? (not required)

Yes No

Are the barriers permanent? (not required)

Yes No

Are the barriers at least 6 feet high and at least 6 feet away from spectators? (not required)

Yes No

If no, height of the barriers (feet) (not required)

If no, minimum distance from spectators (feet) (not required)

Race / rodeo: are spectators permitted in the pit or infield area? (not required)

Yes No

Rodeo: are the transfer areas between the animal pens and the competition closed to the public? (not required)

Yes No

Race / rodeo: will the event feature audience participation (calf scramble, mutton busting, etc.)? (not required)

Yes No

Race / rodeo: is this an off-road event? (not required)

Yes No

Race / rodeo: is this a monster truck show? (not required)

Yes No

Health fair / medical conference: will the event feature any medical or health treatment? (not required)

Yes No

Parade: describe the route from start to finish (not required)

Parade: have local authorities approved the route? (not required)

Yes No

Parade: will the route be secured by local police or private security? (not required)

Yes No

Parade: are participants permitted to throw souvenirs, candy or other items into the crowd? (not required)

Yes No

Will there be carnival or amusement-type rides (including inflatables/bounce houses)? (not required)

Yes No

List all rides and inflatables (not required)

Are all rides and inflatables owned and operated by a third-party vendor carrying general liability limits of at least $1,000,000 / $2,000,000? (not required)

Yes No

Will you be named as an additional insured on the ride vendor's general liability policy? (not required)

Yes No

Will there be any animals on display or petting zoos? (not required)

Yes No

Provide details and a list of the animals (not required)

Will spectators interact with the animals (other than animals provided by an insured third-party vendor)? (not required)

Yes No

Any saddle animals or carriage rides? (not required)

Yes No

Products sold or displayed by concessionaires (describe) (not required)

How many concessionaires will attend the event? (not required)

Will the event include any of these? (check all that apply) (not required)

Firearms Overnight camping or dormitory stays Bonfires Haunted house, hayride or corn maze Spectators in or on the water (swimming, boating, fishing, jet skiing) High-profile attendees (celebrities, dignitaries, elected officials) None of these

Which high-profile guests are attending? (not required)

Will alcohol be served? *

Yes No

Alcohol will be served by: (not required)

Applicant Independent vendors

Will Liquor Liability coverage be obtained? (not required)

Yes No

Liquor liability limits requested (not required)

Average number of attendees consuming alcohol per day (not required)

Will alcohol be sold (cash bar, drink tickets, or built into the admission price)? (not required)

Yes No

Is the applicant a hired bartender or caterer for this event? (not required)

Yes No

Is the applicant a business that regularly sells, serves or furnishes alcohol (bar, brewery, restaurant, caterer)? (not required)

Yes No

Is the applicant the only provider or vendor of alcohol at the event? (not required)

Yes No

Do all of the other alcohol providers carry liquor liability limits equal to or greater than yours? (not required)

Yes No

Is BYOB (bring your own bottle) or self-service of alcohol permitted? (not required)

Yes No

Will alcohol be dispensed by a professional bartender or server who has completed a formal alcohol awareness training course? (not required)

Yes No

The event will end by: (not required)

If after 2 a.m., what time does it end? (not required)

In the past five years, has this event had a liquor liability loss? (not required)

Yes No

Will there be any firework displays? *

Yes No

Name of the pyrotechnician (not required)

Is the pyrotechnician licensed? (not required)

Yes No

Will the display be conducted by a third party carrying general liability limits of at least $1,000,000 / $2,000,000? (not required)

Yes No

Will you be named as an additional insured on that third party's general liability policy? (not required)

Yes No

Will the fireworks be discharged at least 75 feet away from attendees? (not required)

Yes No

Name and address of the person or organization putting on the display (not required)

Will fire department and/or ambulance be on hand? (check all that apply) (not required)

Fire Department Ambulance

I understand the Fireworks Warranty (fireworks displayed at least 50 yards from spectators and parking; aimed away from spectators; a test display shot one hour prior; no wet fireworks used; all fireworks USA-sourced; area policed for debris; pyrotechnicians excluded from all liability coverage) will become part of any fireworks liability coverage issued. (not required)

I understand and agree

Describe the type of security and measures provided (not required)

Who provides security? (not required)

Employees of applicant Local or State Police Independent firm or contractor None

Is the independent security provider required to carry their own general liability insurance? (not required)

Yes No

Security is: (not required)

Armed Unarmed

How would you like us to contact you? (not required)

Type your full legal name to sign this application *

Your title (not required)

Special Event Liability Insurance Application

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📋 Special Event Liability Insurance Application Details

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