Entertainment – Production (Single\Annual\Foreign)admin2018-08-20T19:25:59-07:00 Entertainment - Production (Single\Annual\Foreign) 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 that you have.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 Contact Person* First Last Phone*Email* Enter Email Confirm Email Any prior production insurance?*YesNoPlease provide the policy numbers, premiums and expiration dates of your prior insurance:*Any prior claims?*YesNoAny prior claims?*YesNoAny bankruptcy in the last 5 years?*YesNoWhat do you need covered?* Single Domestic Production DICE\Annual Production Foreign Production Adult Film Production For a single production, please only use the single production (or foreign production as well if needed) Anything that is done by a company based out of the U.S. but filmed in a foreign country (outside the U.S. means anything that is not in the U.S., Canada or any outlying islands, such as Puerto Rico and the U.S. Virgin Islands) needs to have a separate policy for the foreign production. If you are doing a foreign production that includes filming on both the U.S. and a foreign country you will need a policy for each, so please fill out the application for both the Single Production and Foreign Production. The single production policy can cover you for any single production or series. This includes a single season of a television show, a single commercial etc. The DICE policy covers you for multiple productions throughout the year, including feature films, commercials, shorts, specials, documentaries, industrial and educational films. If you are going to be doing multiple productions throughout the year and want an annual policy, this is the correct application. DICE is an insurance term meaning Documentary, Industrial, Commercial & Educational.FOREIGN PRODUCTION INFORMATIONADULT FILM PRODUCTION INFORMATIONDICE\ANNUAL PRODUCTION INFORMATIONThis application provides pricing for an annual production policy, covering 2+ productions a year. Total Annual Budget For All Productions Combined (GPC)*Maximum budget for a single production*Maximum number of days for a single production*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.How many employees do you have?*Anticipated Shooting Locations (City and State)*QUALIFICATION QUESTIONSAny 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 the production include any stunts, pyrotechnics, aircraft, boats, race tracks, race courses, helicopters, motorbikes, snowmobiles, atv, blanks, squibs, guns or other hazardous activities?*YesNoAre there any moving vehicles in the productions?*YesNoWill any animals be used in the productions?*YesNoSINGLE PRODUCTION INFORMATIONThis application will allow us to provide you with a policy for a single production.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 costs 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 as well and costs additional premium. Normally only required when a location or permit office require it.Excess Liability*Excluded$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.Hired and Non-Owned Auto Physical Damage*Excluded$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?*What is the total cost for the renting of all vehicles?*INLAND 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.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$2,500Negative 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/ownerTax 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.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 CommentsThis field is for validation purposes and should be left unchanged.