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*
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*
Is this event co-sponsored?*
YesNo
Co-sponsoring Organization*
Will there be alcohol at the event?*
YesNo
Number of Attendees*
Event Description*
Is an additional Insured Certificate required for the event?*
YesNo
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: