Event Cancellation Application

Client Information

Name of Company/Organization*	Name and type of Event: Has this/have these performance(s) or event(s) been held before? Yes No If so, how often? What is/are the involvement(s) of the Applicant(s) in performance(s) or event(s) and what is/are the experience(s) of the Applicant(s) in this capacity? Is/are the performance(s) or event(s) part of a larger production, promotion, series or tour? Yes No If yes, please state which:
Address (No PO Boxes)*
City*
State*
Zip*
What is the usual business of the applicant? Contact Phone*

If the proposed event is a tour, what will be the method of transport used by Insured person(s)? Equipment?
Event Date(s) & Time(s)
Date:	Time From:	To:
Date:	Time From:	To:
Date:	Time From:	To:
Date:	Time From:	To:
Date:	Time From:	To:

What allowance in the itinerary has been made for:
Travel delay? Set up time? Stand-by dates?

Is the event held:

Event Description:

Indoor?	Yes No
Outdoor?	Yes No
Under Canvas?	Yes No
Other?	Yes No

If other, please specify:

Name of venue where the event will be held:

Street address of venue: City: State: Zip Code:

Will the event venue require construction work?

Yes No

If yes, please provide details:

Venue Details (Location where event takes place)
Will adverse weather conditions preclude the fulfillment of the event? Yes No
If yes, please detail the weather conditions which would cause the event to be canceled:
Would the non-appearance of any individual, group, act, team, etc. preclude the fulfillment of the event? Yes No If yes, please provide details:
Following Questions Are for Non-Appearance Coverage Only
Details of (all) person(s) to be insured. Name(s), age(s) and participation, (only for non-appearance coverage):
Has any person to be insured any history of non-appearance, (only for non-appearance coverage)? Yes No If yes, please provide details:
Has any provision been made for Understudies or Substitutes, (only for non-appearance coverage)? Yes No If yes, please provide details:

Definitions of Categories

A. GROSS REVENUE: All monies paid or payable to the Applicant from every source arising out of the Event. (Note: If Gross Revenue is insured, Expenses and Profit are also insured, because Expenses and Profit added together equals Gross Revenue.)
B. EXPENSES: The total of all costs and charges incurred by the Applicant for, and in connection with, the planning, preparation, and staging of the Event.

Do these sums represent the full extent of your financial responsibilities?
Yes No
If no, please provide details:

If the performance(s) or event(s) has/have been held before under the present management or any other, has there ever been a loss?
Yes No
If yes, please provide full details:

Has the Applicant sustained any loss or damage during the last five years which would have been coverd by this type of insurance had it been in force?
Yes No
If yes, please provide full details:

Has the Applicant had similar insurance, (as applied for herein), declined, canceled or renewal refused?
Yes No
If yes, please provide details:

Are there any other material facts or items of information with regard to the proposed performance(s) or event(s) which should be disclosed? (A material fact is one likely to influence acceptance or assessment of this proposal by Underwriters)?
Yes No
If yes, please provide full details:

Declaration

To the best of my knowledge and belief the information provided in this application, whether in my own hand or not, is true and I have not withheld any material facts. I understand that non-disclosures or misrepresentation of a material fact will entitle the company to void the Insurance. I understand that signing this Application does not bind me to complete the insurance but agree that should an insurance policy be issued, this Application and the statements made therein shall form the basis of the insurance policy.
How did you hear about CSI Insurance?
Preferred contact method	Email - Phone - Fax
Applicant Signature:*
Applicant Title:*