Entertainment – DICE/Annual Production Applicationadmin2018-08-20T19:26:37-07:00 Entertainment - DICE/Annual Production Application CUSTOMER INFORMATIONWhat type of entity is this insurance going to be for?*Choose OneCorporationIndividual or DBAL.L.C.Non-ProfitPartnershipOtherWhat is the name that the insurance will be under?*If you do not have a company, the name on the policy needs to match the name you are using for your vendors, permit offices or any other contracts/agreements you will be signing.Please provide the name(s) of the production's/company's owner(s):*Address (No PO Boxes)* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What year was the production company established?*Contact Person* First Last Phone*Email* Enter Email Confirm Email Any prior production insurance?*YesNoPlease upload loss runs from previous film production coverage, if you have them.You can obtain loss runs from the agent/broker/carrier who provided you with coverage in the past.If you have never had film production insurance before, please provide a copy of the producer/executive producer's resume so that we are able to submit your application toas many underwriters as possible, thereby ensuring that we are able to get you the most affordable quote possible.Please provide the policy numbers, premiums and expiration dates of your prior insurance:*Any prior claims?*YesNoPlease provide the dates, amounts of the claim(s) and descriptions of what happened:*Name 3 productions that this company has completed recently.*If the company has never produced any content before, please say as such.How many productions did the company complete last year?* PRODUCTION INFORMATIONTotal Annual Budget For All Productions Combined (GPC)*Maximum budget for a single production*Maximum number of days for a single production*How many employees do you have?*What is the anticipated annual payroll for cast that you'll hire?*What is the anticipated annual payroll for crew that you'll hire?*Will you be hiring any sub-contractors?*YesNoSub-contractors are people who you pay to come on set and work for you, but are not technically "employees". They should have their own insurance to cover whatever services they're providing to you; and you should be named as additional insured on their policies.How much do you anticipate spending on hiring sub-contractors in the next year?Please provide a list and number of the estimated productions that you will be doing.*i.e. 2 commercials, 3 documentaries, 5 short films etc.Do you plan to use DRONES during any of your productions?*YesNoWill your drone operators be FAA certified, have their own UAV (unmanned aerial vehicle) policy, and be willing/able to name you as additional insured on that policy?YesNoIf not, you will need to notify us when you have drone shoots so that we can schedule the activity for coverage.Please provide a list of the cities and states in which you anticipate shooting. QUALIFICATION QUESTIONSDo you plan to shoot outdoors?*YesNoWill you be producing content for other people exclusively; or do you plan to produce your own short films, documentaries, etc.?*I am strictly in the business of producing content for others.I will be producing my own short films, features, documentaries, etc.I work for others and produce my own projects.Any hard-core or soft-core pornography or live gangster rap music?*YesNoAre there any production activities outside the U.S.?*YesNoAre there any unprotected or open heights above 10 feet?*YesNoAny employees supplied to or from an employee leasing operation? (i.e. PEO)*YesNoWill any of your productions include any stunts, fight scenes, pyrotechnics, aircraft, boats, race tracks, race courses, helicopters, motorbikes, snowmobiles, atv, blanks, squibs, guns or other hazardous activities?*YesNoPlease note that we are not able to offer a policy that covers these types of activities on a blanket basis. If you will be shooting any of these things, you will need to contact us so we can schedule the activities on the policy for coverage.Are there any moving vehicles in the productions?*YesNoWill any animals be used in the productions?*YesNoDo you plan on entering into any co-production activities?*YESNO COVERAGE OPTIONSPlease provide any documents showing required coverage options:Accepted file types: pdf, jpg, doc, docx, png, gif.General LiabilityChoose OneExcluded$1,000,000/$1,000,000$1,000,000/$2,000,000$1,000,000/$3,000,000$2,000,000/$2,000,000$3,000,000/$3,000,000$4,000,000/$4,000,000$5,000,000/$5,000,000Do you need a Waiver of Subrogation?*YesNoThis is not common and will incur an additional premium. A WOS prevents the insurance company from going after the listed entity in the event that a claim is paid and it was actually their fault (such as the location caused someone to trip and fall and the insurance company paid out a claim prior to obtaining knowledge of who was to blame)Do you need Primary Wording?*YesNoThis is not common and will incur an additional premium. Normally only required when a location or permit office require it.Excess Liability*Choose OneExcluded$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000This is ADDITIONAL liability that goes on top of the general liability for higher limits. This is not normally required by most locations, vendors or permit officesAUTO COVERAGEHired and Non-Owned Auto Liability*Excluded$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000This covers auto liability for any vehicle that is not owned by the Named Insured for bodily and property damage. This does not cover damage to the vehicle itself.Will you need the policy to cover damage to rented or borrowed vehicles? If so, please request the auto physical damage coverage in the next question.*YesNoHired and Non-Owned Auto Physical Damage*Excluded$100,000 or less$125,000/$500,000$250,000/$500,000This covers the rented vehicles themselves. If you are renting a grip truck or other vehicle and need full coverage, this must be includedWhat is the total estimated cost of renting production vehicles?*Production vehicles include grip trucks and any vehicle that is not classified as a passenger vehicleWhat is the total estimated cost of renting other vehicles?*This includes passenger vehicles, vans etc. Anything BUT production vehicles.How many vehicles annually?*The total number of vehicle rentals that you will have annually.What is the estimated number of days you will have rented vehicles annually?*Do you plan to rent any 12-or-more passenger vehicles, buses or vans for the primary purpose of transporting people?*YesNoINLAND MARINE COVERAGERented EquipmentExcluded$10,000 or less$15,000$25,000$50,000$75,000$100,000$150,000$200,000$250,000$300,000$400,000$500,000$750,000$1,000,000OtherRented Equipment covers lights, cameras, lenses and other equipment used for production that is not a prop, set or wardrobe.Owned Equipment*ExcludedScheduledUnscheduledOwned equipment covers film production equipment that is owned by the named insured on the policy. Scheduled owned equipment would require a list that reflects the make, model, serial number and replacement value of each item that you'd want the policy to cover. Unscheduled owned equipment would not require such a list, but would be slightly more expensive.What is the replacement value of the equipment you own?This is the overall replacement value of the equipment you own. Depending on who we're able to place you with, you may be required to provide a list of the equipment you want the policy to cover that includes the make, model serial number and replacement value of each item. Props/Sets/WardrobesExcluded$10,000 or less$15,000$25,000$50,000$75,000$100,000$150,000$200,000$250,000$300,000$400,000$500,000$750,000$1,000,000OtherPlease select the deductible for your equipment/props.*$500$1,000$2,500We will try to accommodate your requested deductible; however, certain underwriters do not provide options for deductibles. Please be sure to look over your quote so that you are aware of the deductible that is being offered for coverage.Negative Film, Faulty Stock and Dititized ImageExcludedIncludeThird Party Property DamageExcluded$250,000$500,000$1,000,000$2,000,000Third party property damage covers the location that you are filming at for damage to permanent aspects of the property.Extra ExpenseExcluded$10,000$25,000$50,000$100,000$250,000Extra Expense covers the additional cost in the event of a loss (i.e. your camera breaks and you have to rent a new one last minute)Office ContentsExcluded$10,000$25,000CAST & CREW COVERAGEWorker's Compensation*ExcludeIncludeWorker's compensation covers the cast and crew for injuries while working. It meets the state requirements for coverage if it is available in your state. You can also obtain this from a payroll service in most cases.To provide worker's compensation, please provide one of the following.*Tax ID NumberName and Social Security Number of an officer/ownerA tax ID number is required if you're looking to bind coverage for an LLC, LP or corporation. Social security numbers are only acceptable for coverage being bound to cover individuals/DBAs.Tax ID Number*Name of officer/owner.* First Last Social Security Number of officer/owner*What is the total payroll for all cast and crew?*Accident/Medical Coverage*Exclude$10,000 Per claim per person$25,000 Per claim per person$50,000 Per claim per personAccident/Medical provides reimbursement for medical treatment during the production. It is NOT worker's compensation and does NOT meet state requirements for Worker's Compensation insurance. This is simply a layer of protection for cast and crew for those not purchasing worker's compensation.How many cast/crew members do you need to cover?*Please enter a number from 1 to 2000.Cast Coverage*ExcludeIncludeCast Coverage provides coverage in the event of death or illness to key cast personnel or animals. It compensates you for the additional expense required to replace the actor/animal. THIS WOULD NOT COVER INJURY TO CAST AND CREW. Cast Extra ExpenseExclude100% Of Production Budget75% Of Production Budget50% Of Production Budget25% Of Production BudgetCovered Person Extension (Without Sickness)ExcludeIncludeCovered Person Extension (With Sickness)ExcludeIncludeFamily BereavementExcludeIncludeAnimal Extra ExpenseExclude$10,000$20,000$30,000$40,000$50,000Policy Start Date* Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.