Phone:

804-359-4568

Toll Free:

800-396-6226

Fax:

804-359-6994

E-Mail:

info@commund.com

Special Events Online Quote

Please complete the following and press submit or call 800-396-6226 x202 for an instant phone quote

Inflatables:
Will there be any Inflatables or Bounce-Houses at the event?
Agent Information
Commonwealth Underwriters Agent Code: *Note: this field is optional*

Agency Name:
Agent Name:
first and last name
Phone:
999-999-9999 format
Fax:
999-999-9999 format
Agent Email:
(A copy of the quote will be sent to this address)
Insured Information
Insured Name:
Insured Email: (will only be used to communicate regarding this account)
Insured Address
Insured City
Insured State:
Insured Zip
NOTE: Cannot write special events in Philadelphia.
Risk Details
Number of people attending: (no commas)
Event Address
Event City
Event State
Event Zip
Event Start Date:
Duration of event: days
Event start time: :
Event end time: :
Limit Required:
Does the event require Host Liquor? (Click if Yes)
Will a third-party be serving the liquor? (Click if Yes)
Is there a charge per drink? (Click if Yes)
Is a government entity one of the named insureds? (Click if Yes)
Is security or crowd control provided by the prospective insured? (Click if Yes)
Is the party for someone younger than 21?
Event Classification
Please select your work from the appropriate field(s) below.
NFP = Not For Profit
NOC = Not Otherwise Classified
Is the event hosted by the insured? (Click if Yes)
Please select the type of event:
Is this event Not-For-Profit? (Click if Yes)
Are there lead and follow-up guides? (Click if Yes)
Are there separate entrances and exits? (Click if Yes)
Are there unlit stairs? (Click if Yes)
Is fire used in the Haunted House? (Click if Yes)
Are there any moveable floors? (Click if Yes)
Are there any sinking floors? (Click if Yes)
Is there any touching of spectators? (Click if Yes)
Are there any electric shock devices? (Click if Yes)
Any cardboard construction? (Click if Yes)
Are horses involved? (Click if Yes)
Is the concert played by rock bands? (Click if Yes)
Is the music Electronic, Gothic, Hard Core, Heavy Metal, Hip Hop, or Rap? (Click if Yes)
Will Concert have high profile entertainers? (Click if Yes)
Is this related in any way to Ultimate Fighting or Mixed Martial Arts? (Click if Yes)
Is this is a celebrity wedding? (Click if Yes)
Please provide a brief description of your event:
Additional Exposures:
Additional Insureds (Click if Yes)
Type of Additional Insured:
Number of Additional Insureds:
Add Waiver of Subrogation?
Additional Set-up / Take-down days? (Click if Yes)
Sum of additional set-up and take-down days:
Will there be a fire works exhibition/show in conjunction with the event? (Click if Yes)
Any losses in the last 5 years? (Click if Yes)
Number of losses in the last 5 years:
Any loss over $10,000? (Click if Yes)
Terrorism Coverage
Will insured need Terrorism Coverage? (Click if Yes)
Commission
What commission would you like for this account?
Any Additional Comments:



For higher limits or coverage options not listed, please contact Cindy Rios, Ext 127.

Any questions or problems with the form? Please contact Cindy Rios



Only Commonwealth Underwriters, Ltd. has binding authority. Coverage will not be bound until application has been received, reviewed, and accepted by Commonwealth Underwriters, Ltd.