First Name: |
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Last Name: |
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Business Name: |
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Mailing Address: |
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Mailing City: |
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Mailing State: |
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Mailing Zip Code: |
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Phone Number: |
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Fax Number: |
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E-Mail Address: |
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UNDERWRITING
INFORMATION |
Event Address: |
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Event City: |
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Event State: |
California |
Event Zip Code: |
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Please Describe The Special Event: |
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Number of Days Event Will Run: |
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What Date Do You Expect The Event To Begin: |
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Estimated Attendance Per Day: |
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Total Estimated Participants: |
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What Is The Maximum Capacity Of The Event Location: |
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Total Gross Receipts For The Event: |
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Any Celebrities To Be Present? |
yes no |
Type Of Seating: |
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Crowd Control & Protection: |
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Will Bleachers Or Platforms Be Used? |
yes no |
If Yes, Are They: |
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Does The Special Event Involve Fireworks? |
yes no |
Does The Special Event Involve Amusement Rides? |
yes no |
Does The Special Event Involve Food Sales? |
yes no |
Does The Special Event Involve Alcoholic Beverage Sales? |
yes no |
Is This A Sponsored Event? |
yes no |
Business License Number, If Applicable: |
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License Type, If Applicable: |
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Years of Experience: |
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How Many Years Have You Operated Under This Business Name? |
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Have You Uses Any Other Business Name During The Past 5 Years? |
NoYes |
Losses-Claims In The Past 5 Years: |
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If Yes, Description, Type & Amount Of each loss-claim |
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Liability Limits Requested: |
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Please
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Thank you for your interest.
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