Short-term Production Quote

Please enter the following information, click submit and we will gladly respond with a quotation via e-mail:
items marked with * are required.

Full Contact Name*
Full Name of Business
Mailing Street Address*
Mailing City*
Mailing State* & Zip Code*	State Zip
Type of Entity*
E-mail address*
Telephone*
Fax
How do you wish to be contacted*

Please answer the following questions to determine if the production qualifies for this program*

Underwriting Questions

A.	Does the production include any of the following? Stunts, Pyrotechnics, Aircraft, Boats, Animals, Race Tracks, Race Courses, Helicopters, Motorbikes, Snowmobiles, Blanks, Squibs, Guns, Live Gangster Rap Music, Hard-Core/Soft-Core Porn	YesNo
B.	Is coverage required outside of the U.S. and/or Canada?	YesNo

Claim History

Any prior production with any losses of any kind?

YesNo

Total Budget*	$
Title of Production*
Production Type*
If Music Video
continued
enter artist's name
Location Street Address or Intersection
additional location information	City* State*
Synopsis & brief description of shoot*
Coverage Start Date*	From // 12:01am
Coverage End Date*	to // 12:01am

Amount of rented equipment coverage	$
Amount of props, sets & wardrobe coverage	$
Third party property damage limit	$
$25,000 faulty stock & negative film coverage
Extra expense coverage	$
Amount of Owned Equipment (unscheduled) coverage	$
Desired Liability Limit*	$
City or other special certificate required?
Waiver of subrogation required?
Hired & Non-Owned Automobile coverage options	Liability Physical Damage
Worker's compensation coverage desired? (not available in all states) If yes, answer the next 6-questions	No Yes
Is worker's comp a SAG requirement?	No Yes
Number of shoot days?
Number of full time employees?
Number of part time employees?
Total payroll
Payroll Company (if any)

Additional notes:

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