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 on the date you purchase or your renewal date and goes for one year.
  • - You are listed as the Insured instead of our association name Performers of the U.S.


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

You can now add on an Inland Marine option. This will cover your business personal property and goods while at the show or while in transit. This would cover your equipment and costumes for damage 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 $175 $325
Requested Start Date
E.g., 07/22/2017
What day would you like the policy to start?
(First, Middle Initial, Last Name)
Business name under which you operate (no LLC or Inc.)
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.

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

Select Your Policy and Premium Option

Term of coverage is from November 1 to December 31.

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

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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