Equipment & Contents Policy Holder InformationFull Legal Name of Policy Holder*(As it should appear on insurance policy (i.e name of your studio or business) Contact Person Name* First Last Contact Email* Phone*Website FaxMailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is the MAILING address the same as the PHYSICAL Address?* Yes No Physical AddressPlease enter the physical address of your business if different from the mailing address above Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Please describe your business operation* Have you ever had an equipment claim in the last 5 years?* Yes No Please describe all claims including date, payout, and loss details.Claim #1Claim #2Claim #3Where do you store your equipment the majority of time?* Does this place have an alarm system connected to an outside monitoring company?* Yes No Do you travel with your equipment outside the United States more than 5 times per year?* Yes No Do you ever travel with your equipment to Mexico?* Yes No Does any of your equipment go under water?* Yes No Is it in a waterproof protective case? Yes No Is any single item(s) valued at $150K or more* Yes No Policy TermPlease select one of the following coverage options:* I need a SHORT-TERM POLICY (1 day to 11 months) coverage for RENTED Equipment (not including automobiles) I need an ANNUAL POLICY to cover at least one of the following Equipment types: Owned Production Equipment, Owned Sports, Leisure & Recreation Equipment, Owned Musical Instruments & Sound Equipment, Business Personal Property, Tenant Improvements & Betterments, Rented Equipment from Others Short-Term Coverage: Policy Terms 1 Day to 11 Months - Rented Equipment Coverage Only (No Automobiles)Rented Equipment from Others Limit (Replacement Value, including sales tax, of all equipment being rented) Rental Pick Up Date MM slash DD slash YYYY Rental Return Date MM slash DD slash YYYY Description of equipment being rented Continuing Rental Fees Coverage(If you have a covered claim, this coverage reimburses your rental company for loss of rental income during your claim handling. This coverage has a 72 hour waiting period from the time the claim is reported in writing to the insurance agent or carrier.) None $2,500 $5,000 Currently the policy has a Locked Vehicle Warranty. This means there is no coverage for theft from an UNLOCKED vehicle unless you elect to remove this warranty for an additional 10% of the premium. Would you like to remove this warranty for an additional 10% charge? Yes No Annual Coverage: Policy Term 12 Months - All Eligible Coverages and Options Available (No Automobiles)1. Please complete. At least one limit is required below. Scheduled Items (Other Than Trailers)Owned Production Equipment Owned Production Equipment includes: Cameras, camera equipment, sound, audio visual, lighting and grip equipment, communications equipment, portable electric equipment, editing and projection equipment, office personal property, generators, mechanical effects equipment, props, sets, wardrobe, event equipment, theatrical equipment, computer equipment including desktops,laptops and monitors, and all similar personal property and related production and entertainment equipment Owned Production Equipment LimitEnter the cost to replace your production equipment in the event of a loss (Replacement Cost Value, including sales tax, of all Owned Production Equipment )Owned Production Equipment DescriptionPlease provide description of your production equipment. Owned Sports, Leisure & Recreation Equipment Owned Sports, Leisure & Recreation Equipment includes: Sporting goods and equipment, gym and fitness equipment, business personal property, tenant improvements, sport event property, race timing machines, racing chips, banners, office personal property, ROTC related equipment, and any related Sports & Recreational equipment. Owned Sports, Leisure & Recreational Equipment LimitEnter the cost to replace your sports & recreational equipment in the event of a loss (Replacement Cost Value, including sales tax, of all Owned Sports Equipment )Owned Sports, Leisure & Recreational Equipment DescriptionPlease provide description of your sports and recreation equipment. Tenant Improvements & Betterment Tenant Improvements & Betterment includes: Fixtures, alterations, installations, or additions that become part of a building that you do not own and cannot be legally removed. The tenant improvements and betterments were paid by you and had them installed or personally installed. This does not cover any landlord improvements to the rented space. MUST complete Tenant Betterments section. Tenant Improvements & Betterment LimitEnter the cost to replace your Tenant Improvements & Betterment in the event of a loss (Replacement Cost Value, including sales tax, of all Tenant Improvements and Betterment )Tenant Improvements & Betterments Description Business Personal Property Business Personal Property includes: Office Furniture, lockers, rugs, lamps, telephones, laptops, computers, any other similar business personal property. Business Personal Property LimitEnter the cost to replace your business personal property in the event of a loss (Replacement Cost Value, including sales tax, of all Business Personal Property )Business Personal Property Description Owned Musical Instruments & Sound Equipment Owned Musical & Sound Equipment includes: Musical Instruments, sound equipment, vintage musical instruments, similar personal property, office personal property, and other related musical equipment Owned Musical Instruments & Sound EquipmentMusical Instruments, sound equipment, vintage musical instruments, similar personal property, office personal property, and other related musical equipment.Owned Musical Instruments & Sound Equipment Description Rented Equipment FROM Others Rented Equipment FROM others includes: Any of the above equipment classes rented for use not including tenant betterments and improvements. Rented Equipment FROM Others (Maximum value at any one time)Enter the replacement cost value of the Equipment Rented FROM othersRented Equipment FROM Others Description Please answer the following questions:For equipment you own, is any single item valued at $5,001 or more (replacement cost including sales tax)? Yes No Is the equipment value included in the limits you entered into the Equipment Type Chart (Question 1)? Yes No Please list below ALL single items valued at $5,001 or more showing Make, Model, Serial #, and Replacement Cost (including sales tax). Owned items that are valued at $5,001 or more that are not listed will not be covered under the policy.Do you have any items that are cutom made? Yes No If Yes, do you have any custome made equipment valued over $5,000 a piece? Yes No If yes, please provide the following information in the field below: Description of Custom Made Item, Date Made (if older than 10 years, we will require photos prior to binding), Materials and their Costs, Labor CostsNote - Custom Items require receipt, work order or appraisal in order to provide a quotation Tenant BettermentsIf you listed a limit in the Tenant Improvements & Betterments section in the above limit section of the application, you are required to answer the questions below. Are you requesting Tenant Improvements and Betterments Coverage?*Tenant Betterments require copies of work orders or material and labor receipts in order to be quoted. Please note that Tenant Betterments and Improvements is anything that is permanently fixed or attached to the building structure. If items can be removed without damaging the building structure, they would not be considered Tenant Betterments and Improvements. Yes No List the location address (where the tenant improvements are)* Square Footage of the physical location* What year was the building built?* Is the building older than 50 years old?* Yes No If yes, what year was the Heating updated? If yes, what year was the Electrical updated? If yes, what year was the Plumbing updated? If yes, what year was the Roofing updated? What is the construction type of the building (steel, wood, concrete)? Does the location have a sprinkler system (active system)? Yes No Does the location have a fire and burglar alarm connected to a monitoring service? Yes No What type of security does the premise have, other than burglar/fire alarms? Do you need to insure a Trailer(s)?If yes, please answer the additional trailer questions. Yes No If you need coverage for a trailer(s), you must schedule the trailer(s) below.Provide the Make, Model, Vin#, year built, and Replacement Value with Sales Tax If the Trailer is older than 10 years, photos of the trailers are required to provide a quotation.Do you have any equipment that is permanently attached to the trailer? Yes No If yes, what is the total value of the equipment that is permanently attached to the trailer? Is any single item of the permanently attached equipment over $5,000 a piece? Yes No If yes, please provide scheduled equipment info (make, model, serial number and replacement cost) Where do you store your trailer when not in use? (Please Select One) Personal residence - away from public view Personal resident - on driveway Guarded Parking Lot/garage - not at personal residence location What kind of security does this location have to prevent the public from entering (Please check all that apply) Monitored alarm system (connected to a policy station or alarm company) Unmonitored alarm system (alarm that only makes noise) Locked Fence Guarded Security (monitored 24/7) Does your trailer have an alarm system? Yes No If yes, please describe: Does your trailer have a lock? Yes No If yes, please describe: Do you ever leave the trailer out overnight at a job or event? Yes No If yes, please describe:Will your Equipment be attended/guarded at ALL times (24/7)? (Yes, No, or It will be attended/guarded a majority of the time) Where is it parked when left overnight at a job or event? (Please select one) On the event grounds At the event parking area Optional CoveragesDo you rent any of your owned equipment to the sole custody of others (unaccompanied by you or your employees)? Yes No If yes, what is the maximum replacement value of owned equipment that you rent out to others at any one time (unaccompanied by you or your employees)? Would you like to add coverage for Voluntary Parting and False Pretense?(this covers your equipment if the person/company renting or borrowing your equipment never returns it) Yes No If yes, do you require your renters to sign a rental contract that makes them responsible for damages or theft to your equipment being rented? Yes No Rental Reimbursement Coverage - only available with Owned Equipment Coverage (please select one)If you have a covered claim, this coverage reimburses your rental fees for equipment rented to continue your business operations. None $2,500 $5,000 $10,000 $25,000 Continuing Rental Fees Coverage. Only available with Rented Equipment from Others Coverage (please select one)If you have a covered claim, this coverage reimburses your rental company for loss of rental income during your claim handling. This coverage has a 72 hour time deductible from the time the claim is reported in writing to the insurance agent or carrier. None $2,500 $5,000 $10,000 $25,000 Work Tools and Clothing. Coverage options are per occurrence/per employee limits.This coverage is a separate limit for work related tools and clothing, such as work uniforms None $1,000/$250 $5,000/$500 $10,000/$1,000 Interior/Exterior Plate Glass Coverage.This covers exterior or interior plate glass (i.e. structural glass) installed by either you or your landlord at your business location. This DOES NOT cover Mirrors None $5,000 Business Income and Extra ExpenseIf you have a covered claim, this coverage reimburses you after the waiting period for loss of income and expenses to keep your business running such as rent on another location. This coverage is location specific. None Yes (Maximum Limit $50,000) Do you want to add Business Income coverage?If you have a covered claim, this coverage reimburses you after the waiting period for loss of income. This coverage is location specific. None Yes (Maximum Limit $10,000) If yes, please enter in the limit requested (Maximum Limit: $10,000) Do you want to add Extra Expense coverage?If you have a covered claim, this coverage reimburses you after the waiting period for expenses to keep your business running such as rent on another location. This optional coverage is tied to the scheduled location only, which means the claim has to occur at the scheduled location. None Yes (Maximum Limit $10,000) If yes, please enter in the limit requested (Maximum Limit: $10,000) Enter Limit (Maximum Limit $50,000):Please enter a number less than or equal to 50000.Please schedule the location(s) for the requested Business Income Coverage (description, location address, city, state, zip):Location 1: Location 2: I understand that Business Income and Extra Expense is tied to a scheduled location, which means the claim has to occur at the location(s) listed above.* I understand that Business Income and Extra Expense is tied to a scheduled location, which means the claim has to occur at the location(s) listed above. Business Continuation PlanA business continuation plan would be a written document with a plan of action to get your business up and running to minimize down time based on the following 4 key elements. 1-Office Space. 2-Power for this Space. 3-Connectivity (internet/phone). 4-Technology/Hardware Systems. I understand a Business Continuation Plan must be received in order to bind this coverage. I understand a 72 hour waiting period applies for Business Income and Extra Expense Coverage. In the states of AL, CT, DE, FL, GA, LA, MA, MD, ME, MS, NH, NJ, NY, NC, RI, SC, TX, and VA, the waiting period is increased to 120 hours. I understand a 72 hour waiting period applies for Business Income and Extra Expense Coverage. In the states of AL, CT, DE, FL, GA, LA, MA, MD, ME, MS, NH, NJ, NY, NC, RI, SC, TX, and VA, the waiting period is increased to 120 hours. Locked Vehicle WarrantyThis policy has a Locked Vehicle Warranty, which states there is NO coverage for equipment stolen from an Unlock vehicle. Do you want to remove this warranty and thus add back coverage for equipment stolen from an Unlock vehicle for an additional 10% charge? Yes No Will you ever leave any equipment in your vehicle unattended?* Yes No If yes, what is the maximum value of the equipment left UNATTENDED in your vehicle for OWNED Equipment? If yes, what is the maximum value of the equipment left UNATTENDED in your vehicle for RENTED Equipment? What kind of vehicle will you leave your equipment in (please describe in detail) Does the equipment being insured have a GPS tracking device? Yes No If yes, does the tracking device signal send to a monitored, remote devise or security system? Does the vehicle have an alarm system? Yes No If yes, does the alarm signal go to a monitored, remote device or securtiy system? Please explain What other security measures will be taken to protect the equipment while left in the vehicle? Where will the vehicle be parked when left unattended? (mark all that apply) City Street Residential Street Residential Garage (private home) Residential Shared Garage (i.e. apartment complex) If you marked "Parking Garage" please also mark all that apply below to the parking garage: With 24 hour security guard and surveillance With limited surveillance Restricted Access (Key Card) Fenced Gated Lighted Not Guarded No Lot Attendant Other How frequent will you leave your equipment in an unattended vehicle? Mark all that apply: Only if it's an emergency or rare situation when I cannot store it anywhere else For short periods of time (less than 30 minutes) including for food and bathroom breaks For hours at a time, but not overnight For days at a time, including overnight All the time, including storing it in my vehicle Other frequencies (please desribe) Additional InformationHow did you hear about us?* Disclaimers & Signature I understand that this quote is for equipment coverage and does not apply to vehicles, liability insurance, or workers compensation coverage. I understand that if I take my equipment to the country of Mexico, there is an automatic sub-limit (cap of coverage) of $25,000 total. I understand that coverage is worldwide except for countries with US Sanctions. I Understand that minimum premium is fully earned at policy inception. I understand that if the policy is cancelled, all minimum premium is fully earned and will not be refunded. I understand that my policy has a LOCKED VEHICLE WARRANTY. This means that there is no coverage for theft from an UNLOCKED vehicle unless I elect to remove this warranty for an additional 10% of my premium. I have reviewed and understand the above statements. I certify that the information provided is true and accurate to the best of my knowledge. I understand that providing false information may affect my coverage and even void coverage in the event of a claim. Applicant Name:* EmailThis field is for validation purposes and should be left unchanged. Δ
