Concert/Event Promoters

CONCERT/EVENT PROMOTERS

INSURANCE APPLICATION

BROKER INFORMATION

Broker/Agency Name:
Contact Person:
Address:
City / State / Zip
Phone: / Fax:
E-mail Address: / Website:

GENERAL INFORMATION

1.Name of Insured (Applicant):
2.Address:
Street / City / State / Zip
3.Phone: / Fax:
4.Proposed Effective Date:
5.Additional Insureds and their interests:
6.Address:
Street / City / State / Zip
7.Present/Previous insurance carrier:
8.Has any insurance carrier canceled or refused coverage? Yes No
9.Description of the concerts/events you will be promoting:
Please attach a Schedule of Events which includes date, location, event name and estimated attendance.
10.If concert, type of performance: Pop Rock Jazz C & W Classical Rap/Hip Hop
Other:
11.Are you responsible for security at the events? Yes No
If yes, please complete the Security Section of this application.
12.If a private security firm has been contracted, attach a copy of Certificate naming you as an Additional Insured.
TypeNumberArmed
Uniformed Police Officers / Yes No
Undercover Police Officers / Yes No
Private Security Officers / Yes No
Other / Yes No
13.Type of medical facility/ambulance provided at the event(s)?
14.Is a stage used? Yes NoIf yes, please describe stage:
TypeHeight / Width
Permanent
Temporary
15.If permanent, what systems or physical characteristics keep spectators off stage?
16.If temporary, who is responsible for set up of stage?Insured other
17.Grandstand:TypeNo. / Age in Years
Permanent
Temporary
18.If temporary bleachers used, do you require a Certificate of Insurance? Yes No
Please attach.
19.What percentage of attendance will be festival seating; i.e., non-reserved?
20.How long before scheduled performance time will you allow entry of spectators?
21.Are ushers used? Yes No
22.Describe number and types of gates and turnstiles:
23.What concessions will be sold? / Yes No
24.Is applicant/insured responsible for selling alcoholic beverages? Yes No
If yes, please complete Liquor Liability Section of application.
25.Alcoholic beverages sold by subcontracted vendors? Yes No
If yes, does vendor provide a Certificate of Insurance for Liquor Liability naming you as an additional insured?
If yes, please attach. Yes No
26.Will concessionaires provide you with Certificates on Insurance evidencing products liability with your organization as Additional Insured? Yes No
27.Will any other underlying coverage be provided? Yes No
If yes, please describe:
28.No. of vendors/trade booths: / Kinds of goods sold or displayed:
29.Are all goods finished products, or are there any on site demonstration of skills; i.e., blacksmith, candle making, cooking, etc. being done at the event? Yes No
30.How is this event being advertised?
31.Past experience promoting or producing this type of event:
32.Previous losses:(please describe all losses in excess of $1,500 and attach insurance company loss runs):
33.Do you verify that the facility(ies) you contract with are in compliance with city, state, and township building, safety, and fire codes? Yes No
(NOTE: Facility non-compliance with codes will invalidate insurance)

1. If your organization is a member of a trade group of sanctioning body which hold insurance and/or risk

management seminars and/or meetings, indicate name of association:
35.Is this a sanctioned event? Yes No
If yes, name sanctioning organization:
36.Will you have remote parking? Yes No
37.What arrangements have been made for shuttle service? / Yes No
If yes, please complete Transportation Section of application.
CONTRACTUAL INFORMATION
38.Provide copies of agreements pertaining to your events. Also provide details of other contractual agreements.
39.For instances where subcontractors are utilized, is the proposed named insured listed as an additional insured
under the subcontractor’s policy? Yes No
40.Who has authority to sign contracts on behalf of the proposed named insured and what is the review process?
41.Is there a system in place for obtaining certificates of insurance where applicable? Yes No
If yes, who reviews certificates on behalf of named insured?
What is the minimum limit of general liability coverage requested from each subcontractor?

A.EMPLOYEE BENEFITS LIABILITY

(Please complete this section if you need a quote for Employee Benefits Liability Coverage. If you do not need a quote for Employee Benefits Liability, please skip this section and continue to the next section.)

42.Does applicant have a full-time Personnel Department? Yes No
43.Number of employees under Employee Benefit Program administered in the U.S. or Canada:
44.Employee Benefit Programs which are automatically covered without being specifically listed by the applicant are (check all that apply):
Group Life Insurance / Group Accident or Health Insurance / Profit Sharing Plans / Pension Plans
Employee Stock Subscription Plans / Workers' Compensation / Unemployment Insurance
Disability Benefits Insurance / Social Security Benefits
45.List below any other types of benefit programs the applicant wants the company to consider for inclusion under this insurance:
Type of Benefit Program
46.On programs permitting employees an option to enroll or not to enroll, does the applicant require a signed acceptance or rejection from each employee? Yes No
If yes, is the signed acceptance or rejection retained in the employee's personnel file? Yes No
47.Is a benefit brochure or written explanation of the Employee Benefits Program given to each employee? Yes No
48.Are all benefits available to all employees? Yes No
If no, list all exceptions:
49.Who advises the employees of their benefits?
Personnel Manager / Department Manager / Immediate Supervisor / Other (Please describe):
50.Is there a review of employee questions and a record kept as to each employee's acceptance or rejection of any one or all the benefits? Yes No
51.Has any Error and Omission loss ever been sustained or is any such claim pending against the applicant?
Yes No
If yes, please give details:
52.Has any occurrence taken place in the past that is likely to give rise to a claim? Yes No
If yes, please give details:
53.Number of branches, other business locations:
54.How are employees in branches and other locations advised of benefits?
55.What is the first date any previous Employee Benefits Liability coverage was carried?

B.LIQUOR LIABILITY

(Please complete this section if you need a quote for Liquor Liability Coverage. If you do not need a quote for Liquor Liability, please skip this section and continue to the next section.)

56.Is alcohol sold during events by the Insured/applicant? Yes No
57.Name on liquor license:
58.Liquor license number: / Class of license:
59.Has applicant's liquor license ever been revoked or suspended? Yes No
If yes, please explain:
60.Has applicant incurred claims for liquor liability during the last 3 years? Yes No
If yes, please explain:
61.Has any insurer cancelled or non-renewed coverage during the last 3 years? Yes No
If yes, please explain:
62.Has applicant ever been fined by alcoholic beverage control or other governmental regulator? Yes No
If yes, please explain:
63.Type of beverages sold:
64.Annual Gross Sales:
Liquor Sales $
Food Sales$
Other$
65.Are patrons allowed to carry alcoholic beverages onto the premises? Yes No
If yes, what type?
66.Do you exercise the right of search and seizure of contraband items? Yes No
If yes, how do you notify the public of this?
67.Do you maintain security personnel at entry check points? Yes No
If yes, what type?
68.Are the alcohol sales and consumption contained within one fixed site or are booths/stands located throughout the event site? Yes No
69.Number of servers used?
Professional? Yes No Explain:
Volunteer? Yes No Explain:
70.Do the servers receive any type of alcohol awareness training? Yes No
If yes, please explain:
(attach training manuals used)
71.Median age of liquor customers: 18-25 25-30 30-40 40 and over
72.Explain how ID's are checked:
73.Are uniformed police officers present at the site of alcohol sales? Yes No
If yes, how many?
Are undercover police officers present? Yes No
If yes, how many?
Are private security officers present? Yes No
If yes, how many?
74.Are rules and regulations clearly displayed for patrons viewing? Yes No
Describe:
75.In what size of container is the alcoholic beverage served? Cup oz. Pitcher
Other
76.Is there a limit placed on the quantity of alcoholic beverages purchased at one time? Yes No
Explain:
77.Is the parking area patrolled to prevent intoxicated drivers from leaving the premises? Yes No
Explain:
78.Is there any type of designated driver program? Yes No
Explain:
79.Is there any other underlying liquor liability coverage being provided? Yes No
Explain:
80.Will there be additional limits of liquor liability purchased? Yes No
If yes, what is the additional limit?

C.SECURITY COVERAGE

(Complete only if security is the responsibility of the insured.)

PART I
81.Who is primarily responsible (via contract) for liability coverage for security personnel?
Insured Municipality Subcontractor
Number of security personnel on staff:
Number of security supervisors:
Number on premises:
Number off premises:
82.Do any security personnel carry a firearm as part of their equipment while on duty? Yes No
If yes, number of armed security personnel:
83.Are the security persons employed or contracted by the park? Employed Contracted
("Employed" means the individual is being paid and supervised directly by the insured. "Contract" means the existence of a written contract with another entity for security services that has insurance coverage separate from the insured's policy for security liability.)
Note:If "Employed," please answer Section B., Part I, II, III, and V.
If "Contracted," please answer Section B., Part I, II, III, IV, and V.
84. If applicable, please provide the estimated payroll for employed security persons.
85.Total maximum hours per day permitted at this and all other places of employment:
Total maximum hours per week?
86.What are the staffing guidelines per number of patrons?
87.Are the guidelines determined by: Ordinance, or Statute?
Industry standard? Yes No
Other (please describe):
PART II:
88.Is there a pre-employment screening procedure? Yes No
If yes, please describe:
89.Does the procedure include contacting previous employers over the previous five years? Yes No
90.Do you contact at least three personal references? Yes No
91.Is a psychological screening profile used? Yes No
If "yes," what type:
92.Is a criminal background check made? Yes No
If "yes," what agency is used for the criminal background check?
93.Is completion of a minimum 20 hours initial training program required before deployment? Yes No
94.Who conducts the training and what are the trainers qualifications:
95.Is a minimum of 10 hours on-site training required? Yes No
96.Is a minimum of 4 hours of annual refresher or continuing education training planned and conducted for each security employee? Yes No
97.Is each security person given a personal copy of the training/safety manual? Yes No
If "yes," has each security person given the park written acknowledgment of the policies and contents?
Yes No
NOTE: PLEASE INCLUDE A COPY OF THE MANUAL & A SAMPLE OF THE WRITTEN ACKNOWLEDGMENT.
PART III:
98.Are the security personnel in uniform? Yes No
If "yes," please describe the uniform:
NOTE: PLEASE ATTACH A PHOTOGRAPH OF ONE SECURITY PERSON IN STANDARD UNIFORM.
99.Are the security personnel identified by other than a uniform? Yes No
If "yes," please describe the identification and include an example or photograph.
100.Please indicate any equipment carried or routinely available to security personnel:
Flashlight / Type: / Size: / Construction:
HandcuffsNight Stick (Is Night Stick Police Regulation? Or Other?)
First Aid Kit (including blood borne pathogen kit)
Taser/PhaserChemicals (Mace, pepper gas)
Other:
Firearm - Caliber:.357.38.9mmOther:
Make:ColtS&WRugerOther:
Covered HolsterType:
Is AmmunitionStandardOther:
Firearm and ammunition approved and inspected by park or security company? Yes No
101.Describe capabilities of each guard for constant communications with each other, the supervisor, and park
management:
102.Are dogs used in your security operations? Yes No
If yes, please provide the type of dog(s), number, and describe duties.
PART IV:
103.Date the contracting company began business:
104.Is there a written agreement with contracting company? Yes No
If "yes," Please enclose a complete copy of the written agreement
105.Name of contracting company's liability insurance carrier:
106.Is the park an additional insured on that policy? Yes No
If "yes," please enclose a complete copy of the policy.
107.Is there an established working relationship with local law enforcement? Yes No
If "yes," please describe:
108.Please attach a copy of the contracting company's employment procedures.
109.No. of contracted security personnel: / No. of security supervisors:
110.Are there any suits or legal actions pending against the company? Yes No
If yes, please explain in detail:
111.Is there a procedure to immediately report all incidents to park? Yes No
If yes, please describe:
PART V:
112.Does the supervisor make personal contact with each security person at least once during each shift?
Yes No
If "yes," please describe:
113.Please explain all "no" answers.

D.PYROTECHNICS

(Please complete this section if you need a quote for Pyrotechnics Coverage. If you do not need a quote for Pyrotechnics,please skip this section and continue to the next section.)

114. Limit of liability requested: $1,000,000 Other:
115. Description of Events:
116. Location of Events:
Street / City / State / Zip
117. Dates of Events:
118.Who is the Authority having jurisdiction over the use of pyrotechnics at the facility?
Local Fire Department State Fire Marshal Other (please list):
119.What permit process must be followed prior to use of pyrotechnics at the facility:
120.Please submit the pyrotechnics plan from the most recent use of pyrotechnics for which a permit was obtained.
121.Have you staged pyrotechnic displays before? Yes No
If yes, please list any claims/losses that have occurred and the amount of loss:
Description / Date of Occurrence / Amount of Loss
A.
B.
C.
122.Who will be the pyrotechnics operator?: Named Insured Contractor
Complete this section if thePyrotechnics Operator is the Named Insured
(a) List names of people shooting fireworks and describe their experience.
Please note: This coverage will exclude Bodily Injury Liability to the fireworks shooter.
Name / Experience
(b)Where are the pyrotechnics stored when not in use?
Does it meet Federal/State Storage Regulation? Yes No
What quantity of pyrotechnic material is stored on site (pounds, # of shows, etc):
Describe the type and amount of pyrotechnics used in recurring events (e.g. introductions, home runs, etc.):
Describe what fire prevention and suppression measures are taken to support the pyrotechnic loading and firing
process:
Do you secure proper pyrotechnic permits for each event? Yes No
Are the shooters listed above licensed for pyrotechnics? Yes No
Complete this section if thePyrotechnics Operator is a Contractor.
(a)Name:
(b)Is there an agreement with the contractor? Yes No
If yes, please provide a copy of the agreement.
(c)Will liability coverage be provided by the pyrotechnics contractor? Yes No
If yes, please indicate limits of coverage provided:
$1,000,000 Greater than $1,000,000 Other:
Please attach a copy of certificate of insurance including any additional insured listing
(d)Do you confirm that the contractor has secured the proper pyrotechnic permits for each event?
Yes No
(e) Describe what fire prevention and suppression measures are taken to support the pyrotechnic loading and firing process:
(6)
87. 123.Do you allow tenant users (including temporary tenant users) to conduct pyrotechnic displays either themselves or through a contractor? Yes No
If yes, what steps are taken to ensure that the appropriate permits are granted, appropriate fire safety codes are
met, and that insurance has been obtained from either the tenant or the tenant’s contractor which lists you as an
Additional insured?
If no, does the tenant lease/use agreement indicate that pyrotechnic displays are not permitted? Yes No
124. Are events with pyrotechnics held: Indoors Outdoors
125.What type of pyrotechnics will be displayed (as defined in NFPA code 1126)?
Aerial Shells Airbursts Black Powder Comets
Concussion Effects Concussion Mortars Electric Matches Flares
Flash Pots Flashpowder Gerbs Integral Mortars
Mines Mortars Rockets Saxons
Waterfall, Falls, Park Curtains Wheels Salutes
Other, please list:
OUTDOOR PYROTECHNICS (only complete if outdoor pyrotechnic displays are staged)
126.Are the events in compliance with NFPA 1123 or 1126 (Code for Fireworks Display)? Yes No
127.Is there fencing to keep spectators away from restricted areas during the fireworks shooting? Yes No
If yes, distance of spectator fencing from launch site:
Distance of spectator parking area from launch site:
Distance of closest building or structure from launch site:
128.Will there be firefighting equipment on site during the event? Yes No
129.If no firefighting equipment on site, give distance to nearest fire station:
130.Will you have an ambulance on site? Yes No
If no,(a) what is the estimated response time of an ambulance?
(b) distance to nearest medical facility:
INDOOR PYROTECHNICS (only complete if indoor pyrotechnic displays are staged)
131.Are the events in compliance with NFPA 1126 (Standard Code for the Use of Pyrotechnics before a Proximate Audience)? Yes No
132.Do you verify thatfacility (ies) are sprinklered? Yes No
133.What other form of fire fighting equipment is available at the facility (ies)?
134.Do the facility(ies) have an emergency evacuation plan? Yes No
If yes, how often is the staff drilled on emergency evacuation?
135.Number of accessible (not locked) emergency exits at the facility (ies):
136.What steps are taken to inform patrons of the locations of all emergency exits?
137.Maximum capacity of the facility(ies):
138.Has the fire marshal approved the use of pyrotechnics at the facility? Yes No
If yes, as of what date:

E.TRANSPORTATION

139.Does the promoter own any vehicles? Yes No
If yes, please provide a completed ACORD Auto Application including Auto Schedule
140.Does the promoter allow the use of employees’ personal autos for company business? Yes No
If yes, number of people employed by the promoter:
141.Does the promoter rent vehicles? Yes No
If yes, is rental coverage purchased from the rental agency? Yes No
Estimated number of rental days:
General description of the exposure (transport VIP’s and/or guests, employees run errands, etc., rental/lease, contracted transportation, hauling):
142.Are all drivers covered by workers’ compensation? Yes No
143.Is there a written policy w/respect to the use of company vehicles? Yes No
If yes, explain:
144.Are employees allowed to use company vehicles for personal use? Yes No
145.Can family members drive company vehicles? Yes No
146.Explain the driver selection process (age review, independent MVR review, confirmation of primary insurance, proof of valid drivers license):
147.What does the promoter do if an individual is found to have three or more moving violations or a DUI or an OUI- typeof violation?
148.Does the promoter have a driving safety/training program? Yes No
149.Where are the vehicles being stored?
150.Are there protections in place at the area where vehicles are stored? Yes No
If yes, please explain:
151.Is there a concentration of values or exposure (major exposure is within a certain time frame) with respect to this insured? Yes No
If yes, explain:
152.Does the promoter travel to Canada or Mexico? Yes No
153.Description of any high valued vehicles (over $75k):
154.Does the promoter have a vehicle maintenance program? Yes No
155.What’s the majority radius of the auto fleet?

Please provide the following with this application: