Curtis Moring Insurance Agency, Inc. Think CMI for all your insurance needs.

Business Insurance Coverage
 
General Infomation
Special Events Application
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Name of Organization:
DBA:
Street:
City:
State: Zip Code:
 

Tel. No:
Fax No:
Email Address:
Contact Person:
If more space is needed, fill out a blank sheet & attach to back
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Brief Description of Events:
Applicant's years of experience organizing event:
Applicant's experience conducting similar events
(include numbers, dates, etc.):
Will celebrities be present:
Yes (Provide names)   No
nBusiness Liability Information
Loss Experience from similar prior events
(include nature of loss, date, amount paid/outstanding):
Liability limit desired: Product coverage desired:
Deductible desired:    
nPlatform/Bleacher Information
Which will be used?
Bleachers Platforms
 
Height of bleachers:
Type:
Permanent Portable
 
Age of construction:
Will back &
side railings
be provided:
Yes
  
No
 
Construction:
Concrete
Steel
Wood
Describe condition of bleachers:
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nHazard Liability Information

Will the event involve any of the following hazards?
No hazards
Yes hazards (Check boxes below)

Interest of Applicant
Sponsor
Operator
    
Alcohol Beverage Sales
Food Sales
Amusement Rides
Fireworks

If applicant is sponsor, does
operator have liability insurance:
Yes No
Liability Limits:

Name of Company:

nHazard Liability Information
Have certificates of insurance
been obtained from operator:
Yes No
Does applicant agree to hold
harmless any third party:
Yes No

Is applicant held harmless by others:
(If yes, please email contracts)
Yes No
 
 
       
Curtis Moring
Insurance Agency, Inc.
 
 
License #0719355
 
   
  123 Camino de la Reina, Suite 202 East
  San Diego, CA 92108
   
 
(800) 321-0677
  p: (619) 718-7575
 
f: (619) 718-7565
   
  email:
  information
 
  This form is not an insurance policy or an insurance contract. Your agreement to these terms does not create an insurance contract or agreement. These terms must be accepted by the insurance company before there is any contract or coverage.
 
Serving California consumers since 1963. PRIVACY POLICY.
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San Diego, California 92108. Site design by SFDesign '03. All rights reserved.