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ENTERTAINMENT PRO INSURANCE
   Motion Picture, Television, Theatrical, Music, Broadcasting and Special Events   
   
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Welcome to Motion Picture/Television Production EZ-Quote from Entertainment Pro Insurance.

For fast service on your commercial accounts complete the form below and hit the “Step Two” button. Your submission will be electronically delivered to the next available Commercial Lines Underwriter.
[ Required fields are bordered in red ]
 
  CONTACT INFORMATION
Named Insured (Production Co. or Individual):
 
Entity Type ( Indiv, LLC, LLP, Corp. LLC, Non-Profit, Other):
Physical Street Address (No P.O. Box):
City:
State, Zip Code:
Mailing Address (P.O. Box - okay):
Contact Person:
Phone:
Fax:
E-mail Address:
 
Website Address:
Year Business Established?
  QUALIFICATIONS QUESTIONS
Will production include any hard-core/soft-core pornography or live gangster rap music?
Is this a Co-Production?
Will any production activities take place outside of the U.S. and Canada?
How many productions are planned within the next 12 months?
Any unprotected or open heights above 15 feet or employees?
Any employees supplied to or from an employee leasing operation (i.e. PEO)?
Cast coverage to be included?
  PRIOR COVERAGE / INSURANCE HISTORY
Previous Insurance Carrier and Policy Number:
 
Lines of Coverage:
 
Any Prior Losses / Claims?
Insurance declined or cancelled in the past 3 years? (provide loss runs and /or details)
  PRODUCTION DETAILS
Production Title:  
Type of Production (doc, commi, feature film, music video, etc):  
Estimated Gross Production Coast/Total Project Budget:  
Number of Episodes/Length (if applicable):  
Policy Effective Date (Date Coverage Begins):  
   
Production Start and End Dates
Pre-Production:     
Principal Photography: 
Post-Production:     
 
   
Total Number of Shoot Days:  
Shooting Location(s) - City & State:  
Will the production include any stunts, pyrotechnics, aircraft, boats, animals, auto chase scenes, race tracks, helicopters, motorbikes, snowmobiles, ATV's, blanks, squibs, guns, over water scenes, or other hazardous activities?
 
   
Brief Synopsis:
 
   
Will the production include unusual locations such as:
Public Utilities Premises      Public Transportation      Resort Arenas      Marinas & Docks      Offshore Oil Platforms     
 
 
  FOR MUSIC VIDEOS ONLY
Type of Music:  
Decade of Music:  
Artist Name:  
  PRODUCTION / KEY PERSONNEL
 
Listing of All Officers (to exclude from workers comp):
  First and Last Name Date of Birth Drivers License #/State
Executive Director
Producer
Director
 
COVERAGE OPTIONS
 
  GENERAL LIABILITY
   
Limits of Liability:




 
  Blanket Additional Insured:    Include   Exclude

City/Special Certificates (Permit/City):    Include   Exclude

Waiver of Subrogation:    Include   Exclude
 
  AUTOMOBILE (Hired and Non-Owneed Auto)
   
Liability Limit: Other: 
 
  Physical Damage (per vehicle/aggregate limit):    Include   Exclude

Waiver of Subrogation:    Include   Exclude

Number of Vehicles/Trailers being rented:   Private Passenger    Trucks/Trailers

Number of Rental Days:

Estimated Cost of Hire/rental:
 
  Inland Marine
   
Rented Equipment (Camera, Lighting, Sound, etc) $
Rented Props, Sets & Wardrobe $
Owned Equipment, Props, Sets, Wardrobe $
Negative Film & Faulty Stock $
Faulty Stock, Camera & Processing $
Third Party Property Damage $
Extra Expense $
Office Equipment & Furniture/Contents $
Electronic Data Processing (Computer HW/SW/Media) $
 
 
  WORKERS COMPENSATION
Workers Compensation     Include   Exclude  
     Waiver of Subrogation (only if required by contract)    Include   Exclude
  If needed, please include contract with application
 
    If "Include" is Selected:
 
    1. What is the name of the entity requesting the waiver of subrogation? 
  2. What is their involvement in the event?
  Number of Shoot Days:
  Payroll Company Name (if any):
 
Payroll Classification # Full-Time # Part-Time Volunteers Total Payroll(W-2, 1099, Deferred, Other (Please identify)
Cast/Crew
Office/Clerical
Post Production
Others (Describe)
 
Listing of All Officers (to exclude from workers comp):
First Name Last Name Title/Position
 
   
   
ADDITIONAL COMMENTS:
   
INCLUDE the following items with completed application: * Resumes/Bios of Key Personnel
* Copy of Script
* Shooting Schedule
* Budget
   
 
FOR AGENT USE ONLY
Insurance Agency Name:
Office Street Address:
City:
State, Zip Code:
Agent Contact Person:
Agent Contact Person Email:
Agent Contact Phone Number:
Agent Fax Number:
 
   
  FRAUD STATEMENT
Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: substantial) civil penalties. (Not applicable in CO, HI, NE, OH, OK, OR, VT). In DC, LA, ME, TN and VA, insurance benefits may also be denied.
   
  (You will get a summary page to review before submitting)