Get Insurance to Rent From

Co-Production House LLC
Let's Do This

Annual Productions Application

What is the total number of years of production experience (the owner of the company)?

(This is to insure rented or borrowed vehicles used for production purposes.)
SELECT YES OR NO
COVERAGE
NON-OWNED & HIRED AUTO LIABILITY
SELECT YES OR NO
COVERAGE
NON-OWNED & HIRED AUTO PHYSICAL DAMAGE
Do you allow employees to use their own personal vehicles for your business?
Do all employees who regularly use their cars for business purposes carry minimum personal auto limits? 
Do you obtain Motor Vehicle Reports or keep driver license information on file?

NOTE: IF YOUR PRODUCTION INVOLVES ANY HAZARDOUS ACTIVITIES OR STUNTS, WE CANNOT QUOTE WORKERS COMPENSATION

SELECT YES OR NO
COVERAGE
WORKERS COMPENSATION

Name(s) of Owner(s) must be listed; the below individual(s) can be included or excluded from Workers Compensation:

1.
2.
3.
SELECT YES OR NO
COVERAGE
WAIVER OF SUBROGATION
Select Limits
SELECT YES OR NO
COVERAGE
SELECT LIMITS
GENERAL LIABILITY
3RD PARTY PROPERTY COVERAGE (DAMAGE TO PROPERTY AT RENTED LOCATION I.E FLOORS, WALLS)
CITY / SPECIAL CERTIFICATES (I.E. FILM PERMIT OFFICE)
WAIVER OF SUBROGATION
PRIMARY AND NON-CONTRIBUTORY WORDING
Do music video productions make up more than 50% of your total productions?
SELECT YES OR NO
COVERAGE
EXCESS LIMIT
SELECT LIMITS





  1. YEAR YOUR BUILDING WAS UPDATED FOR

(What does this mean? Watch the video here.)

NOTE: This IS NOT Workers Compensation Coverage. It reimburses medical expenses sustained to cast or crew while participating in the filming operations, excess of any existing health insurance available. If anyone is already covered by Workers Compensation, then they are not eligible for Accident Medical Coverage

SELECT YES OR NO
COVERAGE
ACCIDENT MEDICAL
SELECT ONE LIMIT

(PLEASE LIST ALL THE NAMES AND ADDRESS OF THE LOCATIONS AND RENTAL HOUSES THAT REQUIRE TO BE NAMED AS A CERTIFICATE HOLDER)

  1. 1 Name
  2. A Full Address
  3. B Type Of Certificate Holder (I.E. RENTAL HOUSE, LOCATION, ETC.)
  1. 2 Name
  2. A Full Address
  3. B Type Of Certificate Holder (I.E. RENTAL HOUSE, LOCATION, ETC.)
  1. 3 Name
  2. A Full Address
  3. B Type Of Certificate Holder (I.E. RENTAL HOUSE, LOCATION, ETC.)
  1. 4 Name
  2. A Full Address
  3. B Type Of Certificate Holder (I.E. RENTAL HOUSE, LOCATION, ETC.)

NOTE: Please send a list with additional Certificate Holders if necessary

  1. There may be an Additional Premium due for any changes made after the policy is bound.
  2. Coverage is only valid within the United States. I understand that if I have international activities, I will have to purchase a foreign production policy.
  3. This quoted policies will not include Cast Coverage , Errors & Omissions (the Content or Media Liability of your Film/Project), or any other coverage that was not requested to be quoted on this application. A field left blank will be assumed to mean that you do not want that coverage.
  4. A Broker Fee, Policy Fee and/or Administrative Fee may be charged by Athos Insurance Services for the placement and administrative services provided. All fee amounts will be listed and disclosed on the quote. This fee is fully earned upon binding coverage.
  5. I verify that all the information provided on this application is true and accurate to the best of my knowledge and that I have read and accept the terms above. Misrepresentation of information may make my coverage null and void.
  6. I understand that it is my responsibility to provide Athos Insurance with any insurance requirements I have signed or agreed to, before purchasing any policies. I acknowledge that failure to provide Athos with these requirements may prevent me from receiving the most proper insurance policies and can result in additional premiums due to satisfy requirements after policies have been purchased.
  7. I understand that this application is just a starting point to apply for insurance and may result in additional questions from Athos Insurance, in order to receive better quote options.
  8. If I applied for Rented Equipment From Others coverage, I understand this limit is a shared limit of ALL equipment rented from ALL equipment owners and/or rental houses combined (maximum at any one time). If I rent more than my policy limit, it's my responsibility to contact Athos to increase this maximum limit BEFORE the rental occurs
  9. If your total equipment limits need to be changed, you can revise your quote before purchase OR make changes after you’ve purchased your policy.
  10. I have reviewed the Replacement Cost Valuation & Policy Limits Acknowledgement, which states: When entering values for Rented equipment and/or Rented Props, Sets and Wardrobes please use the REPLACEMENT COST value including SALES TAX. “Replacement Cost” is the cost to replace the gear with new or like-kind in quality equipment today. The Rented Equipment Limit is the total replacement cost value of the equipment you are renting from all owners/rental houses combined.  If you do not have the exact limit, please feel free to provide an estimated total.
(Please type in your full name)
I HAVE READ AND ACKNOWLEGED THE ABOVE