Confidential Quote Request Form

Please complete this form for your confidential quote. Information provided will be used for your insurance purposes only.

Are you an Insurance Agent?*
Type of Organization*
Required Special Event Liability Coverage amount?*
Required Special Event Aggregate Coverage Limit amount?*
Maximum Medical Expense Benefit
Accidental Death and Dismemberment Limit
Deductible Amount
Have you had a liability claim in the past three years? *
Will you have a release waiver on file for each participant?*
If your participants are minors, are parents'/guardians' signatures required for the minors?*
Is the event indoors or outdoors?*
Are you responsible for parking?*
Will inflatables be present at this event?*
Will liquor be sold at this event?*
Are you providing overnight accommodations such as camping?*
Will there be any fireworks or pyrotechnics?*
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