Ozprize & Weather Insurance Specialists is a Corporate Authorised Representative of Insurance Advisernet Australia Pty Ltd. AFSL No. 240549

Corporate Authorised Representative No. 309116 Visit the Insurance Advisernet website

Event Cancellation Quotation Request Form

Event Cancellation and Abandonment

Quotation Request Form

YOUR DETAILS

EVENT DETAILS

YES
NO
YES
NO

Event cancellation

(Only complete if Event Cancellation cover is required)

17. Please enter the budget information for this event:

* Please note that if the event has not been held before, revenue cover is limited to pre-contracted gross revenue only (money secured in advance of the event such as pre sold tickets)

100% Gross Revenue
100% Cost & Expenses
Predominantly* Indoors
Predominantly* outdoors
Predominantly* in temporary structures

*Predominantly means more than 75% of the event

YES
NO
YES
NO
YES
NO
YES
NO
YES
NO

Non appearance

(Only complete if non-appearance cover is required)

YES
NO
a) Key speaker (key speakers, presenters, hosts involved in a speaking only role)-(If so, please complete Question 26)
b) Individual/Group (performers, groups or entertainers)-(If so, please complete Question 26)
c) Simultaneous (Covers 25% of participants* due to Common Cause)-(If so, please complete Question 27)

*Participants are defined as players, athletes, performers or other groups of individuals who are contracted to perform at the event and whose performance is critical to its successful fulfilment

26. Key speaker/Performer details :

YES
NO
YES
NO
YES
NO
YES
NO
YES
NO

Public Liability

(Only complete if Public Liability cover is required)

$5m
$10m
$20m
YES
NO
YES
NO

  *Dangerous activities include, but are not limited to: Fireworks, bonfires, pyrotechnical devices, inflatable play equipment, fairground rides or mechanically propelled rides of any kind, ballooning, quad bikes, go-karts or motor sport of any kind, trampolines or gymnastic apparatus of anykind, circus acts or stunt acts, shooting ranges for guns or archery.  


Bouncy castles, inflatable play equipment, slides or rides (mechanical or otherwise) which are set up, operated and taken down by a bona fide sub contractor who has provided you with evidence of their current public liability insurance, shall not be  classed as dangerous activities  

YES
NO
YES
NO

If so, please provide full details of the activities including safety measures and confirmation as to whether the Insured provides or operates any activity or equipment themselves, or if they are provided, operated and supplied by fully insured 3rd party contractors

Event Cancellation General Questions

(Only complete if Cancellation cover is required)

YES
NO
YES
NO
YES
NO

Declaration

I/we declare that the information disclosed on this proposal, is to the best of my/our knowledge and belief both accurate and complete. I/we have taken care not to make any misrepresentation in the disclosure of this information and understand that all information provided is relevant to the acceptance and assessment of this insurance, the terms on which it is accepted and the premium charged.
YES
NO

Event Liability General Questions

(Only complete if Liability cover is required)

YES
NO

Declaration

You Declare that You:

  • have never been prosecuted under the Health and Safety at Work Act or other Statute or regulation
  • have not been convicted of any criminal offence (other than minor driving offences not resulting in disqualification) in the last 5 years
  • have not been declared bankrupt nor been involved in a company or business which has gone into liquidation, receivership or come to an arrangement with creditors in the last five years
  • have not waived any legal rights of recovery against contractors and exhibitors?
  • have checked contracts when booking venues to ensure we are not accepting responsibility for the negligence of the venue owners
  • require all contractors, performers and exhibitors to provide evidence of insurance against third party liability risks before they are permitted on site
  • require all exhibitors to provide evidence of insurance against third party risks before we permit them onsite
  • have carried out and implemented/will implement a written risk assessment in respect of the event
  • has a written health and safety policy detailing procedures applied to the event that all contractors/exhibitors are made aware of and are required to comply with

Signature (sign this declaration for all sections selected)


I/We declare that the information provided above and in all appending sections is true to the best of My/Our knowledge.

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