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For California residents only.

After you've completed this form, click on the SUBMIT button to apply for your Special Events Program Insurance. Please phone us with any questions at 760-644-03514.
Customer Information
Eligible Event
Insured Name
Mailing Address
City
State
Zip Code
Contact Person
E-mail
Website
Home Phone
Work Phone
FAX

Location of Event:
Name of Event
Event Type
Event Date(s) include set up and/or tear down days
Location of Event
List the names of any performers appearing at tis event:
Total estimated attendance (maximum 10 days)
Are overnight stay or camping accommodations provided by the event organizer? Yes No
Will there be an admission charged for this event? Yes No
Is alcohol being served? Yes No
Is alcohol being sold? Yes No
If yes, who holds the liquor license?

Detailed description of event:

Eligible Additional Insureds:
Name & Address
of Additional Insured #1
Relationship? Owner / Lessor or premises Sponsor Co-promoter
Name & Address
of Additional Insured #2
Relationship? Owner / Lessor or premises Sponsor Co-promoter

Reporting Method
How would you like to receive
your free Special Events Insurance quote?		 U.S.Postal E-mail Fax

 

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