Event Cancellation Insurance Application


All fields are required for an accurate quote. Thank you.

Insured: (Organization holding the event)

City: State: Zip: Telephone:
Website: http:// Contact Person:

Event to Be Insured:

Name of Event:
Event Date: Start: End:
Type of Event:
Consumer Show Other
Name of Facility:
Address of Facility:
City: State: Zip:

Financial Information:

Budgeted Revenue from the Event: $
Budgeted Expenses from the Event: $
Budgeted Net Income/Loss: $

General Questions:

Is the event open to the general public? Yes  No
Is coverage for non-appearance of any person required for this event? If yes, provide details. Yes  No
Is your event utilizing teleconferencing or satellite communications? If yes, provide details. Yes  No
Is any part of the event to be held outdoors, in a tent, or in a temporary structure? Yes  No
Is the facility to be used under construction or being renovated? Yes  No
Do you have written contracts between you and the facility? Yes  No
Have all the necessary arrangements essential to a satisfactory event been made? Yes  No
Do you have a contingency plan if your event is delayed or postponed? Yes  No
Has the event to be insured ever suffered a previous insured loss? Yes  No
Is the applicant aware of any circumstance that may possibly result in a claim under this insurance? Yes  No
Please provide details here:

Completion of this application does not bind either the applicant or the underwriter to provide the insurance. This will allow our office to obtain quotes for various resources. A final, signed application from the selected provider of insurance may be required to bind coverage if desired.

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