October 24, 2014

Special Event Insurance Quote

CONTACT INFORMATION:

First Name (required) :     Last Name (required):

Entity Type     Business Name / Non-Profit Name (if applicable):    

Your Street Address(required):     City (required) :     State (required):     Zip Code (required):
    Phone (required):     Your Email (required):     Best Time To Reach You


EVENT DETAILS:

Type of Event Your Roll   Event Description

Policy Effective Date (required) : Month   Day   Year     Start Time

Policy Ending Date (required) : Month   Day   Year     End Time

Average Daily attendance:     Number of Participants / Performers    Venue Name:

Event Address(required):     City (required):     Event State:     Zip Code (required):

Budget: (Total Cost of Event):     Cost of Admission     Event Will Be Held:


ADDITIONAL NAMED INSUREDS INFORMATION:

Please input the Additional Named Insured /Venue Information (AI) - name, address, phone number, and email or website address if available:
AI 1 Name     AI 1 Address

Phone AI 1     Email AI 1   AI 1 Location Info:


LIQUOR LIABILITY:

Are Alcoholic Beverages being Served?     Are you Selling Alcoholic Beverages?

FILL OUT THE REMAINDER OF THIS SECTION ONLY IF SELLING ALCOHOLIC BEVERAGES FOR PROFIT :

Is Applicant Sole Vendor of Alcohol at Event?     If No, list Other Vendors Serving Alcohol

Are All Alcohol Vendors Required to Carry Minimum Liquor Liability Limits for this Event

Will Alcohol be Dispensed by a Professional Bartender?     If No, Will Alcohol be Self - Serve?

Liquor License number & County Issued (We will need a copy of license - required prior to binding policy)

Any Reported or Potenial Liquor Liability Claims within last 5 Years?     If Yes, provide dates, description, and status:


Include a Message  

Should you have any questions, please call us at 916-984-9320.  You may also email a copy of documents to: Info@barraganinsurance.com

Barragan Insurance Agency

90 Blue Ravine Road Ste 74

Folsom, CA 95630

Fax: 916-984-8013