Online Order Form: Performer & Entertainer Insurance

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Provide your information in the form below

Provide your payment information on the form

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We email your certificate of insurance

START YOUR PURCHASE
Name*
First Last
Do you have a business name or DBA (doing business as) - If you choose no, then you confirm that you do not have a business name. You understand that the First and Last Name above will appear on my Certificate of Insurance.*
Enter your business name or DBA*
Address*
Street Address Address Line 2 City State ZIP Code
You enter YOUR address in this section.
Email*
Enter Email Confirm Email
This is where we will email the proof of insurance.
Phone*
Choose Your Start Date and Limits
Choose your Policy Start Date*
Date Format: MM slash DD slash YYYY

The date must be today or later. If it is after normal business hours. your start date may not be today and will be tomorrow.
Please select your desired length of coverage (price includes administrative fee). All purchases, premium and fees are fully earned and non refundable.*
- Program Rate 5 consecutive days or less: $150.00
- Program Rate 6-14 days: $200.00
- Program Rate 15-30 days: $250.00
- Program Rate 1-6 months: $375.00
- Program Rate 6 months - Annual: $450.00
Limits of Insurance*
- $1,000,000 per occurrence / $1,000,000 aggregate
- $1,000,000 per occurrence / $2,000,000 aggregate (add 5% to price shown above)
-If you need higher limits, please call us at 949-270-0609 or use the online chat below.
Information About Your Business and/or Events
Please tell us what events you are working
Event Location(s)
If you do not know the exact location, please provide the city and state.
Description of Performance(s)*
Example: face painting at a party or DJ at a wedding
What Type of Performer are You?*
If you have a group of disc jockeys (not an individual), please call us at 949-270-0609 (you cannot quote this online)
What type of Other Performer?*
**If you choose other, we may need to obtain approval prior to obtaining coverage. *Hypnotists are not eligible for this program.
Review Your Coverage and Terms
$1,000,000 General Aggregate
$1,000,000 Products/Completed Operations
$1,000,000 Personal & Advertising Injury
$1,000,000 Each Occurrence
$300,000 Fire Damage (any one fire)
$5,000 Medical Expense
-0- Deductible Per Claim
Inclusions/Program Highlights:

- Occurrence-Form Policy
- Up to 3 Additional Insureds may be added at no additional premium charge
- Coverage issued through Sports & Recreation Providers Assn. Purchasing Group

Exclusions: Aircraft, all acts of terrorism, asbestos liability, claims made by athletic participants, employment related practices, fungi and bacteria, hepatitis, HIV, HTVL, AIDS, transmissible spongiform encephalopathy, lead poisoning, nuclear energy liability, pyrotechnics activity, total pollution, violation of the CAN-SPAM act, war liability and liability for occurrences prior to the effective date and time of coverage. All of the above are subject to the terms and conditions of the policy.
Optional Additional Insureds
We will email you a certificate of insurance, but if you need to add any additional insureds now, you can choose that here.
Do you want to add any additional insureds now? 3 are included at no charge and each additional after that is $10. You can add these later.*
Provide the name and address of each additional insured.*
3 are included at no charge and each additional after that is $10. If you provide more than 3 names and addresses, you will be charged $10 for each additional one.
Enter your Payment Information
Credit Card Number*
ENTER NUMBER AS: xxxx-xxxx-xxxx-xxxx Credit Card Types Accepted: Visa, MasterCard, Discover, American Express
Expiration Date Month*
Year*
3 Digit Code (4 digits on American Express)*
Enter the 3 digit code from the back of your card (on an American Express there is a 4 digit number on the front top-right)
Final Section - Underwriting Terms
PERSONAL ACKNOWLEDGEMENT Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud and may be subject to civil fines and criminal punishment. Premium is fully earned upon inception. There are no return premiums for cancellations.

I certify that the information provided in this application is correct in its entirety, to the best of my knowledge.

This purchase is fully earned and non refundable.

You warrant, represent and confirm that all of the following are true:

1.Your performance WILL NOT involve Fireworks or Firearm Ammunition.
2.Your prior coverage has been NOT canceled or non-renewed.
3.You have NOT had any insurance claims in the last five (5) years.
4.Your exhibit or performance will NOT include mechanical or inflatable amusement devices.
5. You have no employees.
6. You are over 18 years old and only perform in the United States.

** Your payment will be processed within in the same business day if you submit this form during business hours. If your payment information is not valid or does not clear, we will attempt to contact you. Once you receive a certificate of insurance, you can consider the coverage to be bound, and not before that.

BUY PUSHING THE SUBMIT BUTTON BELOW, YOU ACKNOWLEDGE THE ABOVE.
Electronic Signature - type your name below as your electronic signature. This will be a substitute for your physical (handwritten) signature.*
First Last

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Pricing Information

Limits of Liability Starting at:
$1,000,000 per occurrence/$1,000,000 aggregate

– Program Rate 1-5 consecutive days:	$150.00
– Program Rate 6-14 days:	$200.00
– Program Rate 15-30 days:	$250.00
– Program Rate 1-6 months:	$375.00
– Program Rate Annual	$450.00

Please note that a $100.00 Administrative Fee is included in the prices shown. In Florida, add 1.3% for FHCF.

Questions?

Call us at 949-270-0609 or
use the online chat below.

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If you complete this form after normal business hours, we will make our best effort to send you a certificate of insurance in the same day, otherwise, we will send it the following business day.

Online Order Form: Performer & Entertainer Insurance

Provide your information in the form below

Provide your payment information on the form

We email your certificate of insurance

START YOUR PURCHASE

Choose Your Start Date and Limits

Information About Your Business and/or Events

Review Your Coverage and Terms

Optional Additional Insureds

Enter your Payment Information

Final Section - Underwriting Terms

Questions?