vendor-sign-up-application - Stratum Insurance Agency LLC

Contact Name*

First Last

Email Address*

Enter Email Confirm Email

This where we will send you the link

Name of Event or Swap Meet or Mall*

Provide the name of your event, swap meet, flea market, mall, or venue where you have vendors.

Description of Event or Location*

For example: swap meet, concert festival, shopping mall with vendors

Address of Event of Swap Meet*

Street Address Address Line 2 City State ZIP Country

Do you have a separate mailing address?

Mailing Address

Street Address Address Line 2 City State ZIP Code

If you event or swap meet does NOT take place where you can receive mail, please provide your mailing address here.

Phone*

This phone number is just in case we need to reach you.

Do you have a specific certificate holder name or additional insured name?

This is the name that goes on the bottom left of the proof of insurance certificate. For example, if your event is owned by a specific company, please provide the full name and address here.

Provide the name and address of the certificate holder or additional insured below.

This is usually your company or the business that owns the event, festival or swap meet.

Estimated Vendors at your Event*

You can estimate,

All policies include a per occurrence liability limit of $1 million and $1 million aggregate. Do you require your vendors to purchase a higher aggregate limit?

Sometimes you will see this written as $1,000,000 per occurrence / $1,000,000 aggregate. The second number is called the aggregate. Think of it as the most a policy will pay in the event of multiple claims. You can change this later if you need to.

Enter below any additional email addresses where you would like to automated proof of insurance to be sent.

This is optional

Do you want to provide any additional information?

Group Vendor Form