Event Cancellation

Indemnity Application

1. Indemnified: (Association or Organization holding the Event)
2. EVENT TO BE INSURED:
*If you have multiple future events, please complete the supplemental event application.
3. FINANCIAL INFORMATION:
4. Provide the percentage of gross revenue from:
**A copy of the budget is required with the application if the budgeted revenue or expenses exceeds $1,000,000.
5. Does the financial information represent the entire gross revenue or expense of the event?
Yes
No
6. Has this event been held before?
Yes
No
7. Is coverage for non-appearance of any person required for the event?
Yes
No


8. Is your event going to utilize teleconferencing or satellite communications?
Yes
No


9. Is any part of the event to be held outdoors, in a tent, or in a temporary non-permanent structures?
Yes
No

10. Do written contracts exist between you and the facility?
Yes
No
11. Have all the necessary arrangements essential to a satisfactory event been made?
Yes
No
12. Is the facility under construction or major renovation?
Yes
No
13. Do you have a contingency plan if your event is delayed or postponed?
Yes
No

14. FUTURE EVENT INFORMATION (BEYOND THE NEXT 12 MONTHS)
Has your organization decided where your events will be held in the future beyond what is provided above?
Yes
No

15. FUTURE EVENT(S) TO BE INSURED (BEYOND THE NEXT 12 MONTHS)
*If you have multiple future events, please complete the supplemental event application.
16. FINANCIAL INFORMATION (BEYOND THE NEXT 12 MONTHS):
17. PRIOR CLAIMS & PRE-EXISTING POTENTIAL LOSS
Are you aware of any circumstances, currently existing or threatened that may possibly result in a claim under this contract?
Yes
No


NOTE: If you become aware of any such circumstances after completing this application, and before the date indemnification for the event commences, you must disclose the circumstances to the insurers immediately, as this may affect the indemnification.
18. Are you aware of any circumstances, currently existing or threatened that may possibly result in a claim under this contract?
Yes
No


PLEASE READ AND AGREE BELOW:
Agreeing this application and declaration does not bind either the applicant or the underwriter to provide the indemnification. In the event there is any material change in the answers to the questions herein prior to the issuance date of the policy, the application form would be considered inaccurate or incomplete. The applicant will notify the insurer in writing, and, if necessary, any outstanding quotation may be modified or withdrawn. It is agreed that this application and declaration shall be attached to and form part of any policy which may subsequently be issued. The undersigned applicant represents that the statements set forth in this application and its attachments and other materials submitted to the insurer are true and correct.
I agree with this declaration