event cancellation insurance
application


1. APPLICANT DETAILS
Entity to be insured (holding the event)
Primary Contact Name *
Primary Contact Name
Address *
Address
Phone *
Phone
Fax
Fax
http://
What is the involvement of the applicant in the event? *
Please select the item that best describes the applicant's role in the event
2. EVENT DETAILS
Address of Venue/Hotel/Convention Center *
Address of Venue/Hotel/Convention Center
Date Lease Begins (Allowing for installation and dismantling) *
Date Lease Begins (Allowing for installation and dismantling)
Date Lease Ends (Allowing for installation and dismantling) *
Date Lease Ends (Allowing for installation and dismantling)
Open Dates of Event - Beginning *
Open Dates of Event - Beginning
Date Event opens to public and/or participants
Open Dates of Event - Ending *
Open Dates of Event - Ending
Date Event is closed to public and/or participants
Alternate dates if any - From
Alternate dates if any - From
Alternate dates if any - To
Alternate dates if any - To
Will the event be *
Are you looking to insure adverse weather for the outdoor portion of an event? *
If yes, please complete the Outdoor Event supplemental application
If you have multiple events, please provide a schedule including event name, location, dates of event, financial information, and sum (limit) to be insured. This information can be emailed to info@nicholashillgroup.com
3. Type of event
Check one
Type of Event *
4. Financial information
Do you want to insure Gross Revenue or Expenses? *
Select One
$
$
$
A copy of the budget is required with the application if the budgeted gross revenue or expenses exceed $1,000,000
Does any party other than the applicant have an interest in the Gross Revenue noted above? *
If yes, provide full details below
Do you have a Ticket Refund Policy? *
If yes, provide full details below. If no, then how do you intend to handle refunds and what procedure do you have in place?
Has this event been held before? *
If no, please provide details of the applicant’s experience in organizing events
Is this event open to the public? *
Have all contractual arrangements necessary for the successful fulfillment of the Event been made and confirmed in writing? *
Have all permits, contracts, visas, licenses or the like necessary of the event to be completed successfully been obtained at the time of this application or will they be obtained in good time prior to the start of the event? *
Is the venue under construction or major renovation? *
Number of hours
Is coverage for non-appearance of any person required for the event? *
If yes, please complete the Non-Appearance supplemental application.
Do you wish to purchase terrorism coverage? Please make your selection below *
Are you aware of any circumstances, currently existing or threatened, that may possibly result in a claim under this insurance? *
If yes, provide details. NOTE: If you become aware of any such circumstances after completing this application, and before the date insurance for the event commences, you must disclose the circumstances to the insurers immediately, as this may affect this insurance.
Have you at any time within the last 5 years had a loss, or circumstances which could have led to a loss which would have been covered by this insurance? *
If yes, provide details
Please provide details or type "NO" below
PLEASE READ AND SIGN (By typing your name) BELOW:
Signing this application and declaration does not bind either the application or the underwriter to provide the insurance. In the event there is any material change in the answers to the questions herein prior to the issuance date of the policy, the application form would be considered inaccurate or incomplete. The applicant will notify the insurer in writing, and, if necessary, any outstanding quotation may be modified or withdrawn. It is agreed that this application and declaration shall be attached to and form part of any policy which may subsequently be issued. To be signed by the Insured The undersigned applicant represents that the statements set forth in this application and its attachments and other materials submitted to the insurer are true and correct. In accepting any quotation provided by result of this proposal request, the insured warrants that all information and answers provided in this application are true and correct. Should an insurance policy be written, this application and any supporting information shall be incorporated into and form the basis of the written insurance policy. The Insured so warrants: *
By typing your name below, you are hereby agreeing to the terms outlined above and providing your personal warranty that all answers and responses that have been provided are true and accurate. Please note: All quotations are subject to the receipt and acceptable review of the application and other underwriting information by the underwriter. *
By typing your name below, you are hereby agreeing to the terms outlined above and providing your personal warranty that all answers and responses that have been provided are true and accurate. Please note: All quotations are subject to the receipt and acceptable review of the application and other underwriting information by the underwriter.
Date *
Date
Please note: this event cancellation insurance application is subject to full underwriting. the decision to provide a quote or not is, in part, determined by the answers you have provided in the above application. Should a policy be issued, it will include certain exclusions and limitations. it is the applicant/insured's responsibility to read and understand the terms in any policy that is issued and bound. not all insurance products are available in all states. please contact the nicholas hill group with any product questions. all insurance products are provided by licensed representatives.
Agent Signature: Ryan E. Hill
Agency: Nicholas Hill Group, Inc.
EVENT CANCELLATION INSURANCE - OUTDOOR EVENT SUPPLEMENT
Only complete this Outdoor event supplement if all, or a portion of your event takes place outdoors
Entity to be insured (holding the event)
Primary Contact Name *
Primary Contact Name
$
$
Is the venue or any surrounding area that is being used for the event exposed to strong wind, flood or water logging? *
If yes, please provide full detail below
Will the stage or area in which the performers work be covered by a roof and on three sides and will all electrical equipment be protected to comply with industry standards against adverse weather? *
If yes, please provide full details below
If no, please give details of what protections, if any, are in place
PLEASE READ AND SIGN BELOW: To be signed by the Insured The undersigned applicant represents that the statements set forth in this supplemental application and its attachments and other materials submitted to the insurer are true and correct. In accepting any quotation provided by result of this proposal request, the insured warrants that all information and answers provided in this supplemental application are true and correct.
The Insured so warrants: *
By typing your name below, you are hereby agreeing to the terms outlined above and providing your personal warranty that all answers and responses that have been provided are true and accurate. Please Note: All quotations are subject to the receipt and acceptable review of the application and other underwriting information by the underwriter. *
By typing your name below, you are hereby agreeing to the terms outlined above and providing your personal warranty that all answers and responses that have been provided are true and accurate. Please Note: All quotations are subject to the receipt and acceptable review of the application and other underwriting information by the underwriter.
Date *
Date