Event Insurance Request Form

Event Insurance Costs

$1M/2M coverage

Please note that the insurer may change the fees without notice, so we will be in touch if the fee varies from this list.

	No Alcohol	With Alcohol	Need Certificate Holder (No Alcohol)	Need Certificate Holder (Alcohol)
Number of Attendees
0-250	$100	$200	$150	$300
251-500	$200	$300	$300	$450
501-750	$300	$400	$450	$600
751-1000	$400	$500	$600	$750

*Events with more than 1000 people request a quote.

Committee Name
Your Name
First NameLast Name
Your Role
E-mail
example@example.com
Your Phone Number
Format: (000) 000-0000.
Event Name
Type of Event
Event Date
MonthDayYear
Date
Event Start Time
Hour Minutes
AM/PM Option
Event End Time
Hour Minutes
AM/PM Option
Name of Venue
Venue Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Venue Contact Name
First NameLast Name
Venue Contact Email
example@example.com
Venue Contact Phone Number
Format: (000) 000-0000.
Is this event co-sponsored?
Co-sponsoring Organization
Will there be alcohol at the event?
Number of Attendees
Event Description
Is an additional Insured Certificate required for the event?
Legal Entity Name for Organization (Insured Certificate)
Just put N/A if a certificate is not required
Mailing Address to Appear on Certificate
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Should be Empty: