Create Performer Application

Performers of the U.S. Entertainer Insurance Application

Instructions

Specialty Insurance Agency, LLC • P.O. Box 24, New Richmond, WI 54017 Phone: 715-246-8908 • Fax: 715-246-4257

Program Description

This insurance program has been designed for the individual U.S. based performer who is a sole proprietor/independent contractor; that is entertaining the public. The policy provides protection against bodily injury to a spectator or property damage to performing premises. You must have a U.S. mailing address to be eligible for consideration of coverage under this policy and the premium must be in U.S. dollars.

Operations Not Eligible

These exposures/activities listed are not covered by this program and any resulting claims will be denied: Hypnotists, rigging, instruction to others for aerial, fire or dance, zip line stunts, grandstands, fireworks, pyrotechnic devices, your business, your business employees or subcontractors, trackless trains, moonwalks, jump houses or other amusement rides and attractions. Using animals, mammals, fowl in your performance is not allowed. Magicians are approved to use a rabbit and/or dove during their performance.

Carrier

Coverage underwritten by Evanston Insurance Company; a carrier rated A (excellent)

  • - The limits of coverage are per membership and not shared.
  • - Your coverage starts: when your application is approved; on the date you select; on your renewal date; or date your renewal was processed and goes for one year.


Coverage provided under this program includes

Commercial General Liability with Additional Insured Endorsement, Waiver of Subrogation, Primary Non-Contributory Endorsement – coverage that protects the insured against liability claims for bodily injury and property damage arising out of their operations.
Legal Liability to Audience Participants – coverage that offers protection against bodily injury liability claims brought by persons participating in covered activities.
Medical Payment for Audience Participants - coverage that pays the medical and dental expenses incurred by a participant when an accidental injury occurs while participating in your covered activities. The coverage is provided on a primary basis.

New Optional Coverage: Business Personal Property - Inland Marine

Inland Marine will cover your business personal property (equipment and costumes) and goods while stored, in transit to a show or while at a show for damages or if stolen. This option is available per policy period. You can add at any time but the coverage will end on your general liability policy expiration date.

Business Personal Property - Inland Marine Option 1 Limits Option 2 Limits
Each Occurrence $10,000 $25,000
Deductible for Covered Losses $250 $250
Deductible for Theft Losses $500 $500
Premium Cost $200 $375

***Optional Coverage: Entertainer Assitant

The duties of the entertainer’s assistant(s) can be as follows:
Works with the insured for set-up and tear down, helps with the planning and organization of a show or booking, works with contracts, coordinates permits and requesting additional insured certificates, handles prop changes during the show, assists with crowd control, is a staged spectator that is called upon to assist with an act, acts as a safety coordinator. This option is available per policy period. You can add at any time but the coverage will end on your general liability policy expiration date. You can use different assistants.

Key to this coverage: An assistant is low risk personnel that would not stop the show from going on if they were not there.

***Optional Coverage: Sexual Abuse and Molestation (SAM)

Many schools in California and Illinois require that you carry Sexual Abuse and Molestation (SAM) coverage in addition to your general liability coverage before they permit you on the school grounds. We offer two different coverage limits.

Sexual Abuse or Molestation (SAM) Option 1 Limits **Option 2 Limits**
Each Occurrence $100,000 $1,000,000
General Aggregate $300,000 $2,000,000
Premium Cost $130.00 $700.00
  • Option 1: Valid in all 50 States, Canada and U.S. owned territories
  • Option 2: **Only valid in the School Districts of California and Illinois**

This coverage follows your general liability dates and cannot be prorated. If you currently have an active policy and are interested in adding this coverage, you can give the office a call and pay with a credit/debit card or you can mail a check.

Requested Start Date *
We are not able to back date insurance. What day would you like the policy to start?
Single Event Coverage will run for 10 consecutive days.
E.g., 01/17/2021
(First, Middle Initial, Last Name)
Business name under which you operate (no LLC or Inc.)
Birth Date
E.g., 01/17/2021
Please Enter State Abbreviation
Ex: Florida = FL

General Information

Check The Boxes Below That Best Describes Your Performance

Group 1

Operations Not Eligible:

Trackless trains, moonwalks, jump houses or other amusement rides and attractions, black henna, grandstand bleachers, hypnotist, performing with animals (note: magicians are allowed to perform with rabbits and doves). Audience participation is not allowed with whip cracking. Use of gun powder is not allowed.

Group 2

Operations Not Eligible:

Aerial or fire performing instruction to others, rigging for other performers, zip line performances, sky walking (tight wire), fireworks and pyrotechnic devices.

Note: If you make over $300,000 you are not eligible for this insurance program. Please contact us for other options.

Provide a detailed description of your performance below. Attach additional pages if needed.

Select Your General Liability Limits of Coverage and Optional Inland Marine Coverage

You checked boxes above to best describe what you do. These boxes are in two groups.

  1. In step 3 you checked boxes that best described your performance. You are in the highest group you checked. If you checked a box in group 2 you are covered for all performer types in group 1 but your premium is group 2.
  2. Check the box for the Option 1 or Option 2 Limits of Coverage that you need.

Commercial General Liability Coverage Option 1 Limits Option 2 Limits
Each Occurance $1,000,000 $3,000,000
General Aggregate $2,000,000 $5,000,000
Products-Completed Operations Aggregate $2,000,000 $5,000,000
Personal and Advertising Injury $1,000,000 $3,000,000
Damage to Rented Premises (Fire Legal Liability) $300,000 $300,000
Medical Expenses $5,000 $5,000
Medical Payments for Audience Participants $5,000 $5,000
Deductible $0 $0
Sexual Abuse or Molestation (SAM) Option 1 Limits **Option 2 Limits**
Each Occurrence $100,000 $1,000,000
General Aggregate $300,000 $2,000,000
Premium Cost $130.00 $700.00

Select Your Policy and Premium Option

Coverage is for a single event that runs up to 10 days.

Option 2: Only valid in the School Districts of California and Illinois

OPTIONAL RIDER (Select only one):
Business & Personal Property - Inland Marine click here for details

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Clear signature
Click and hold down your left mouse button inside the Client Signature box. Use your mouse curser as a pen to write your name. When done, simply let go of your left mouse button.

REQUIRED FIELD - If the signature box is left blank we are unable to process your application.

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