Online Film Insurance Quote

Production Company (or Individual) Contact Information

Qualification Questions: (All answers REQUIRED)

Any: Live Gangster Rap Music, Hard-Core/Soft-Core Porn? (If Yes, please describe in comments at bottom of page)		Yes		No
Any Unprotected or working, open heights above 15 feet off the ground? (If Yes, please describe in comments at bottom of page)		Yes		No
Any employees supplied to or from an employee leasing operation or payroll service (like a PEO)? (If Yes, please describe in comments at bottom of page)		Yes		No
Is coverage required outside of the U.S. and Canada? (If Yes, please describe in comments at bottom of page)		Yes		No
Please confirm your understanding that only one production can be covered by a single short term production policy, if the policy is issued?		Yes		No
Have you had any prior productions with any losses of any kind? (If Yes, please describe in comments at bottom of page)		Yes		No

Production Details

Title of Production	*REQUIRED
Type of Production	*REQUIRED (ind. feature, short film, documentary, commercial, music video, etc.)
Budget	$ *REQUIRED (Gross Total Production Cost, or Net Insurable Production Cost, if you know that)
Total Rented Auto Cost	$ *REQUIRED (include cost for all cars, vans, trucks & trailers)
Payroll - Cast	$
Payroll - Crew	$
Location filming	%
Studio filming	%
DISCOUNT: Do you require a certificate of general liability from ALL subcontractors, naming you as "additional insured" with limits no less than your own policy limits, and keep all certificates on file?		Yes		No
Will children under 18 be included in the production?		Yes		No
Description/Synopsis of script/project Must be at least 111 characters long	*REQUIRED
Cities & States of Shooting Locations	*REQUIRED

Stunts and special general liability:

Will the production include any: * REQUIRED Stunts or choreographed fight scenes Pyrotechnics Aircraft, helicopters, trains, motorbikes or snowmobiles Filming near water, boats or watercraft Animals Blanks or squibs Guns with the ability to fire Jumps or falls of more than 3 inches Vehicles under their own power on camera (describe) "Precision driving of vehicles" (includes off-road, race track, skidding, collisions, speeding, etc. and/or with stunt drivers)

Yes

No

(If Yes to any of the above, please describe in comments at bottom of page)

For Music Videos Only

Type of Music
Music Decade
Artist Name

Key Personnel - At least one executive producer or producer must be listed. Driver's License number and state are required

Role	First & Last Name	Drivers License #	DL State of Issue	Country of Residence
*REQUIRED	*REQUIRED	*REQUIRED	*REQUIRED	*REQUIRED

Coverage Options

First Day of Principal Photography	*REQUIRED
First Desired Effective Day of Coverage (should be on or before the above)
Last Day of Principal Photography	*REQUIRED
Expiration Day of Coverage (should be on or after the above)

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"Inland Marine" Coverages - related to property/items at varying locations
note that deductibles are set based on limit requested

Rented Equipment Replacement Cost Minimum Premium: About $325, includes up to the first $100,000	$	(minimum $25,000, if coverage desired)
Equipment owned by your production company (owned equipment floater) Limit	$	(minimum $10,000, if coverage desired)
Props, Sets, Wardrobe Limit Minimum Premium: About $321	$	(minimum $25,000, if coverage desired)
Negative Film/Faulty Stock/Hard Drives (Limit equals the budget, up to $250,000)		Include		Exclude
Extra Expense (see coverage definitions here)		$10,000		$25,000
		$50,000		$100,000
		declined
Third Party Property Damage (Care, Custody & Control) Minimum Premium: About $333		$250,000		$500,000
IMPORTANT: Also covers damage to locations (as well as borrowed items) while in the care, custody and control of the production		$1,000,000		$1,500,000
		$2,000,000		declined
General Liability Coverages (MUST select one) - this coverage is REQUIRED Minimum Premium: $505 for any production less than 11 days of principal photography (Covers bystanders and non-involved third parties) Per occurrrence/aggregate limit		$1,000,000/$1,000,000
		$1,000,000/$2,000,000
		$2,000,000/$2,000,000
		$3,000,000/$3,000,000
		$4,000,000/$4,000,000
		$5,000,000/$5,000,000
General Liability Options
Blanket Additional Insureds/Certificates of Insurance	Already Included in Short Term Single Production Package
SPECIAL City Certificates (these are normally not required) Minimum Premium: About $265		Include		Exclude
Waiver of Subrogation (a.k.a. Waiver of transfer of rights, only applies if previously required in a contract you have with someone) Minimum Premium: About $265		Include		Exclude
Hired & Non-Owned Auto
Auto Liability Minimum Premium: About $313 A great coverage! Covers anybody driving any vehicle, any time for a purpose involved with the production. Note this is a liability coverage - covers bodily injury and property damage to 3rd parties, not damage to the vehicles in use with the production		$1,000,000
		$2,000,000
		$3,000,000
		$4,000,000
		$5,000,000
		declined
Hired Auto Physical damage Minimum Premium: About $305		$125,000/$500,000
(limit is per vehicle/aggregate)		$250,000/$500,000
		declined
Workers Compensation Minimum Premium: About $600 Note: Does NOT cover volunteers
Is Workers Compensation (on the job illness or injury) & Employers Liability coverage desired?		Yes		No
Workers Comp: # of Shoot Days
Workers Comp: # of Full Time Cast & Crew
Workers Comp: # of Part-Time Cast & Crew
Workers Comp: Total Payroll Dollar Amount (full value of 1099 contracts + all employee wages + value of deferments)
Workers Comp: Payroll Type(s) used: e.g. W-2, 1099, Deferred, or a combination
Workers Comp: Payroll Company Name (if any)
Workers Comp: Names & Titles of All Production Company Owners & Officers This is a long field - you can keep typing in it
Workers Comp: Do owners & officers wish to have or not have coverage?		Include		Exclude
Volunteer Accident Coverage Minimum Premium: $253 for $25,000 excess	Note: This coverage is not currently available from Rio Grande in California, but you may be able to obtain directly from companies such as Francis L Dean
Total # of volunteers
Max # of volunteers on set simultaneously
Limit, per volunteer:	$5,000 $10,000 $15,000 $25,000 $50,000 $100,000 $200,000 coverage declined
Would you like primary or excess coverage? (primary pays before/with volunteers' health insurance, excess pays only after or if volunteers do not have health insurance)		Primary, if available		Excess
"Cast Extra Expense" Coverages This coverage pays for additional production expenditures incurred as a result of cast sickness or accident, but does not pay for medical expenses, which would be covered by Work Comp or volunteer medical
Do you want "Cast Extra Expense" accident coverage?		Yes		No
Do you want "Cast Extra Expense" sickness coverage? (requires physician completed forms)		Yes		No
# of cast to cover for above
Do you want "Cast Extra Expense" coverage in pre-production?		Yes		No
Do you want "Cast Extra Expense" coverage in post-production?		Yes		No

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Please enter any additional comments or considerations. If your production includes stunts, animals, blanks, squibs, guns, jumps, driving, water, boats, pyrotechnics, falls, fight scenes, trains, vehicles under their own power on camera or any "precision driving of vehicles" (skidding, collisions, speeding, etc and/or with stunt drivers), please describe in detail: