Special Event Accident & Liability Insurance

Accidents can happen anytime and anywhere. AIS can protect your employees, volunteers and customers around the clock. Our coverages will protect you while traveling with a business group, vacationing with family and friends or while attending a church social. Our special event accident and liability insurance programs are specifically designed to help eliminate the financial burden caused by costly medical bills or civil litigation.

Wedding Receptions	Educational Exhibitions	Antique Shows	Basketball Clinics
Boy or Girl Scouts	Flower Shows	Bazaars	Bicycle Races
Marathons	Trade Shows	Classical Music Concerts	Rodeos
Soap Box Derbies	Garden Shows	Traveling Business Groups	Marital Arts Tournaments
4-H Clubs	Auctions	Volunteer Fire Companies	Sporting Events
Beauty Contests	Luncheons	Cave Exploration	Fishing Derbies
Parades	Graduations	JTPA	Field Trips
Fairs and Carnivals	Banquets	Tractor Pulls	Auto Shows
JROTC	Fashion Shows	Proms	Conventions
Zoo Outings	Telethons	Church Youth Groups	Exhibitor/Vendor
Ski Trips	Consumer Shows	Picnics	Fraternal Organizations

In addition to the above, we insure most special events.

No matter how "risky" an activity may seem, an insured can feel confident that the coverage is crafted carefully and expertly to serve their needs.

Applicant Information

* Contact Name:
* Entity / Organization:	* Contact Email:
* Mailing Address:	* Phone:
* City:	Fax:
* State:	* Send Quote via:	Email Fax Mail
* Zip:

Event Details

* Event Start Date:
* Event End Date
* Event Start Time
* Event End Time
* Name of event
* Location of event
* Does the facility carry liability insurance		Yes No Not Sure
* Description of event
Are you the host of the event?		Yes No
Are you an exhibitor or a vendor?		Exhibitor Vendor
What is the number of vendors or trade booths?
* Does the event include athletics or sports activities?		Yes No

* Would you like to add spectator / premise only coverage?

Yes No

* What is the seating capacity of the event?

* What is the estimated attendance per day?

* What are the estimated gross receipts?

* Would you like to purchase general liability & accident coverage?

Yes No

If yes, please answer the following:

Sport to be covered

Number of Youth Participants
(18 & Under)

Number of Adults Participants
(19 & Over)

Activity

Number of Days

Does your activity have any participants that are staying overnight?

Yes No

Limits of Liability Requested

General Aggregate	1 Mil 2 Mil
Products Aggregate	1 Mil
Each Occurrence	1 Mil
Personal/Adv Injury	1 Mil
Fire Damage	$300,000
Medical Expense Payments	$5,000

Optional Accident Insurance

Accident Insurance (Limits up to $100,000 available). Please specify desired limit.
What is the number of participants to be covered under accident insurance?
What is the number of spectators to be covered under accident insurance?

Add Additional Insured

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

Add Additional Insured 2

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

Liquor at this Event

* Will liquor be sold at this event?

Yes No

If yes, please answer the following
if you would like a quotation for optional liquor liability coverage:

Estimated number of attendees consuming alcholol daily?
Are all participating alcohol vendors required to carry minimum liquor liability limits for this event?		Yes No
Is a liquor license (or liquor permit) required for this event?		Yes No
Does application have a valid liquor license?		Yes No
Estimated gross receipts per day alcohol
Total estimated gross receipts for event for alcohol
Has the applicant had a liquor loss in the last 5 years?		Yes No
If yes, please describe?

Additional Event Information

* Is the applicant providing any overnight accommodations, such as camping?	Yes No
* If yes, please describe?
* Who is responsible for providing security?

Prior Insurance Experience

Please fax, mail or email premium and loss experience for the past 5 years to (970) 926-7599.

Please describe any losses over $5,000.00
Has this event been held in the past by the appliant?	Yes No
If yes, number of years?
* Has your prior insurance ever been cancelled?	Yes No
* Has your prior insurance ever refused to renew?	Yes No
* Do you have a Risk Management Plan?	Yes No

Please fax to (970) 926-7599, mail, or email all Lease and Hold Harmless Agreements, brochures of the event and a diagram of location(s) to be used.

Security Code

Enter Security Code:

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Insuring Agreement

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly provides false information in an application for insurance may be guilty of a crime and may be subject to civil fines and criminal penalties. I certify that the above information is true and coverage is not in force until accepted by Anthony Insurance Services, Inc. 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 or on the date requested, whichever is later. I 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.

* Agree to terms (type name in box)

Special Events Form

Wedding Liability Form

Contact Us at:
Anthony Insurance Services Inc
PO Box 576
Edwards, CO 81632
Toll Free: (877) 811-2271
Fax: (970) 926-7599

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