Special Events

GENERAL INFORMATION

Contact Name *

Applicant Name *

Phone *

Fax

Referral Code

Mailing Address: including full address and zip code

Address *

Unit, Suite, Room, Apt

City *

Zip *

How did you hear about us?

E-mail address *

Website

Certificate Holder

Additional Insured Waiver of Subrogation

Address *

Unit, Suite, Room, Apt

City *

Zip *

Please Specify your Category?

Organizer Vendor

LET'S GET ACQUAINTED

Describe Your Business or Exhibitions or Special Events

EVENT INFORMATION

Party requiring a Certificate of Insurance: Venue Organizer Other

Name *

Address *

Unit, Suite, Room, Apt

City *

Zip *

Title/Name of Event *

Date(s) of Event *

Daily Attendance at Event

Type of Event *

Name of Current Insurance Carrier

Additional Questions and Comments

Useful Event Documentation

Insurance Requirements

Upload File

Loss History (for last five years)
Description of Loss, Amount of Loss, and Date

None Yes, describe below

Special Events

TRUSTED ONE STOP INSURANCE
FOR THE ART COMMUNITY

800.921.1008

FIVE EASY QUESTIONS: QUESTIONNAIRE FOR GENERAL LIABILITY

GENERAL INFORMATION

LET'S GET ACQUAINTED

EVENT INFORMATION

Special Events

TRUSTED ONE STOP INSURANCE FOR THE ART COMMUNITY

800.921.1008

FIVE EASY QUESTIONS: QUESTIONNAIRE FOR GENERAL LIABILITY

GENERAL INFORMATION

LET'S GET ACQUAINTED

EVENT INFORMATION

TRUSTED ONE STOP INSURANCE
FOR THE ART COMMUNITY