Special Events EZ-App

For Fast Service on your commercial accounts complete the form below. Your submission will be electronically delivered to the next available Commercial Underwriter.

Name of Insured: Producer Code: Producer Contact Person Producer Fax Number: Producer Email: Street Address:

Event Information

Date of Event:

Hours of Event: Address of Event: Describe Location of Event: Coverage dates required: (If other than event date) Estimated Attendance: (Per Day) Total Estimated Participants: Gross Receipts: Detailed description of event: Event will be held:

Crowd Control: (Type and Number)

Ushers: Private Security: (State if Armed or Unarmed) Off Duty Police: (State Armed or Unarmed) Police: Applicants experience in conducting events of this or similar nature (Number, Dates etc.) Any Celebrities to be present? (If Yes Provide Name(s) Will Bleachers or Platforms be used? (If Yes, Permanent or Portable)

Does Event Involve: (Check all that apply)

Fireworks Amusement Rides or Devices Food Sales Alcoholic Beverage Sales Loss Exp. from prior events of same or similar nature: Limits of Liability Desired?

Request for additional insured(s)(Yes or No): Yes No

Special Events EZ-App

Event Information

Crowd Control: (Type and Number)

Does Event Involve: (Check all that apply)

THIS FORM IS NOT AN INSURANCE POLICY OR AN INSURANCE CONTRACT