AnthonyInsuranceServices.com
Dance

Request Wedding Liability Coverage

Step 1 - Complete Application.

Applicant Information

* Contact First Name:
* Contact Last Name:
* Mailing Address:
* Contact Email:
* City:
* Phone:
* State:
Fax:
* Zip:
 
 

Physical Address

Physical address is same as Mailing Address
Physical Address:
   
City:
   
State:
    
Zip:
   

Event Location

* Name of Location:
   
* Address:
* Phone:
* City:
Fax:
* State:
    
* Zip:
 

Event Dates

* Event Start Date:
* Time:
 :

* Time:
 :
Does the facility carry liability insurance?
Yes No Not Sure
Description of Event:
Estimated Attendance:

Premium Rates & Benefits

Please check all plan numbers that apply for General Liability Insurance. Minimum Premiums are fully earned at policy inception.

 

1 million per occurence with 1 million aggregate

1 million per occurence with 2 million aggregate
1 Day Wedding with less than 1,000 in attendance (program rate).
 $250 $262.50
OR
1 Day Wedding with 1,001 to 2,000 in attendance (program rate).
 $295 $309.75
OR
3 Day Package with less than 1,000 in attendance (program rate).
 $295 $309.75
OR
3 Day Package with 1,001 to 2,000 in attendance (program rate).
 $345 $362.25
* Policy Total $

Additional Insured 1

Name:
Address:
City:
State:
Zip:
Relationship:

Additional Insured 2

Name:
Address:
City:
State:
Zip:
Relationship:

Additional Information

* How did you hear about us?

Security Code

security code
Enter Security Code:
 


Insuring Agreement

Coverage is subject to the receipt of payment of the required premium by Anthony Insurance Services, Inc. Coverage will begin on the date of acceptance and payment has been received or on the date requested, whichever is later. Insurance must be purchased before the start of the event. Understand that the premium is fully earned upon policy inception. Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits application of files containing false or deceptive statement is guilty of insurance fraud.

*

 

Contact Us at:
Anthony Insurance Services Inc
9362 Teddy Lane
Suite 203
Lone Tree, CO 80124
Toll Free: (877) 811-2271
Fax: (303) 773-0111