-

Event Application
Client Information
Organization Information
Company/Organization:*
Entity Type:
Address:(No PO Boxes):*
Suite, Floor, ect..:
City:*
State - Zipcode:*
Contact Information
First Name:*
Last Name:*
Phone:*
Email:*


Event Details
Event Name:*
Venue Name:*
Venue Contact:*
Venue Contact Email:*
Venue Contact Phone:*
Address:*
Address Additional:
City:*
State, Zipcode*
Event Website:
Daily attendance:*
Estimated Total Attendance:*
Description of Event:*
Event Dates
Event Start Date:*
 MM/DD/YEAR
Event End Date:*
 MM/DD/YEAR
Set-up Date:*
 MM/DD/YEAR
Tear Down Date:*
 MM/DD/YEAR
If the coverage start date is more than 5 days before the event start date OR the coverage end date is more than 5 days after the event date, please explain:
Other Details
Is the event outdoors?
How many years has the event been held under current management? (If never, enter 0)
During this time has the insured had any claims regarding this event?
Is there a musical performance associated with this event?
Will there be security at the insured events?
Gross Revenue:$
Expenses:$


Coverages
General Liability
Each Occurrence
What is covered?
As part of the AMP insurance program you are receiving a quote for limits of $1,000,000 per occurrence $2,000,000 aggregate at the same cost as the $500,000 limits the city requires for permitting. Please check your contract with the venue for the exact amount of coverage you may need to provide.
Liquor Liability / Host Liquor Liability (Occurrence Aggregate)

What is covered?
Liquor liability provides covers the following losses for which you may be held liable for: 1) causing or contributing to the intoxication of a person, 2) The accidental furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol, or 3) Any statute, ordinance, or regulation relating to the sale, gift, distribution, or use of alcoholic beverages. Note that host liquor is not included without purchasing liquor liability coverage.

Host Liquor Liability
Part of the CGL, this covers the incidental serving of alcohol by an insured who is not in the business of serving alcohol.

Liquor Liability
Insurance that protects your business against loss or damages claimed as a result of a patron of your business becoming intoxicated and injuring themselves or others. If your business manufactures, sells, serves, or facilitates the uses or purchase of alcohol

Property
Rented Equipment, Props, Sets & Wardrobes (optional)
What is covered?
Camera, sound, lighting and miscellaneous rented equipment. Owned equipment is not covered. Props, sets, and wardrobe are covered.
Automobile
Hired/Non-Owned Liability (optional)
Hired/Non-Owned Auto Physical Damage (Occ/Agg) 25k / 100k (optional)
What is covered?
Liability for vehicles rented or borrowed for the event. Liability covers injury to third parties or damage to their property.
Waiver of Subrogation: (optional)
What is covered?
The named insured's intentional relinquishing of any right to recover damages from another party who may be responsible.


Additional Insureds
If the event is being held on city property, the following will be automatically included as an Additional Insured.

City of Austin, attn.: 
Parks and Recreation Department,
P.O. Box 1088,
Austin, Texas 78767.
Additional Insured
Name:
Address:
City:
State, Zipcode:
Phone:
Fax:
Email:
Relationship: Artist - Venue - Sponsor - Government




FRAUD STATEMENT Signing this application does not bind the Applicant or the Company to complete the insurance, but it is understood and agreed that the information contained herein shall be the basis of the contract should a policy be issued. If any of the above questions have been answered fraudulently or in such a way as to conceal or misrepresent any material fact or circumstance concerning this insurance or the subject thereof, the entire policy shall be void.
* I/We have read the above and agree that to the best of my/our knowledge and belief same fully represents the true statement of facts.


Applicant
Preferred contact method
 Email - Phone - Fax
Applicant Signature:*
Applicant Title:*