Sports 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: -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY * Send Quote via: Email Fax Mail * Zip:     Event Details Event Start Date: Event End Date * 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 -- Camp Clinic League Race Tournament -- Camp Clinic League Race Tournament -- Camp Clinic League Race Tournament -- Camp Clinic League Race Tournament -- Camp Clinic League Race Tournament 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 Add Additional Insured Name: Address: City: State: -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY Zip: Relationship: Add Additional Insured 2 Name: Address: City: State: -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY Zip: Relationship: Prior Insurance Experience Please fax, mail or email premium and loss experience for the past 5 years to (303) 773-0111. Please describe any losses over $5,000.00 * 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 (303) 773-0111, 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: 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)