Event Insurance Quote Request

1. Applicant

2. Event

3. Activities

4. Warranty

Applicant Information

Named Insured:

Full Name:

Address:

Line 2:

City:

State:

Zip: -

Phone:

Fax:

Email:

Event Information

Event Name:

Single day only? Yes

Dates: to

Rain Dates: to

Address:

Line 2:

City:

State:

Zip: -

Type:

Public Event?

Daily Attendence:

Alcohol Available?

Need Liquor License?

Liability Limit:

Activity Information

1. Is this event held annually?

2. Will there be any concessionaires, exhibitors, or vendors?

3. Are any of the following events/activities offered?

Activist rallies/marches/literature distribution
Athletic events and competitions
Bungee operation
Cinematography & photography - commercial
Concerts
Dunk tanks
Events held on airport premises
Events with room accommodations/camping
Fireworks/pyrotechnics
Gun/knife shows
Haunted attractions

Inflatable recreational devices
Health fairs/shows
Historic battle reenactments
In or on water activities (of any sort)
Mazes (corn/hay/fence)
Motorized vehicle activities (of any sort)
Overnight retreat
Parades
Petting zoos or animals
Rides or mechanical amusement devices
Rodeos (of any sort)

Warranty

I understand that the insurance company, in determining whether to provide insurance coverage, will rely on the information contained in this form and all other information being submitted. I hereby warrant, represent and confirm that, to the best of my knowledge, all the information provided is complete, true and correct.

Yes

I am aware that the insurance company expects accurate reporting for my premium calculation, and should my figures exceed my estimates during the coverage term I will make arrangements to pay the additional premium. I understand that my books and records may be examined or audited by the insurance company at any time during the coverage period and up to three years thereafter. Intentional misrepresentation or misreporting may jeopardize coverage. K&K reserves the right to decline/void any ineligible coverage.

Yes

Notice

The insurance quote tools we provide on our website are specifically designed to make obtaining a quote easier. However, any premiums provided or terms outlined are only an indication of what coverage may be available and are not a policy. The results of any online quote should not be construed as proof of insurance coverage. All premiums and the issuance of an actual insurance policy are subject to each insurance carrier's underwriting guidelines.