GENERAL INFORMATION REQUIRED

1) Client / Company name :

Client Contact name :

A.B.N.

2) Postal address :

3) Phone number :

Fax number :

4) Email address :

Website :

5) Business activities to be insured (please describe your activities in as much detail as possible)

6) Please tick one or more of the following to best describe your business activities

Entertainer/Performer/Musician/Band etc.Theatre/Performance GroupDrama/Dance SchoolBooking AgencyEvent Organiser/Concert PromoterMarket OrganiserCommunity Group/Non-Profit OrganizationFilm or Video ProductionPublic Address, Lighting, Audio Visual, Staging or RiggingOther

7) How many years experience do you have in this field and/or how long has your business been operating for?

8) Period that cover is required for:-
Annual period ( ) Dates From To

or

Short term period ( ) Dates From To

9) Limit of cover required :-
$10,000,000$20,000,000$50,000,000

10) Location of risk (please provide address or location of where you will be predominantly carrying out your business activities):-

11) Do you carry out any activities outside of Australia?
YESNO

(Please provide names of countries)

12) Please advise the estimated turnover/wages of your business for the next 12 month period?

Turnover $:

Wages $:

If cover is only required for a short term period or one-off event, please provide the estimated turnover or budget for the short term period/one-off event.

13) Number of employees

If you are a non-profit organisation, total number of members

14) Do you use contractors / sub-contractors?
YESNO

15) Do you insist on your contractors / sub-contractors carrying their own public liability insurance? (This will be a condition of cover) YESNO

16) Will you be signing any contracts that contain hold harmless or indemnity agreements? YESNO

If yes, please provide copies of such agreements.

Note – a hold harmless or indemnity agreement is whereby one party assumes the liability risks of another party under contract. Your public liability policy is to cover your legal liability & no one else’s, therefore claims arising from these agreements are excluded. In some circumstances, your policy can be amended to include cover for these agreements providing your Insurer can review them & agree to their content. If you sign these agreements without first referring them to your Insurer, you may not be covered in the event of a claim.

17) Will you require cover for liability claims arising from loss or damage to other people’s property whilst in your care, custody or control? YESNO

If yes, please advise limit of cover required?
$

Note – the above extension only operates if you are negligent in causing the loss or damage to the property in your care, custody or control. There can be situations where you have hired or borrowed other people’s property, & such property is lost or damage not as a result of your negligence. However, you may still be responsible for compensating the owner for their loss. In these circumstances, it would be prudent not to rely on the above extension on it’s own but also insure the hired or borrowed property under a General property insurance policy, which will operate regardless of fault or negligence.

18) Have you suffered any public liability claims or have caused incidents that could give rise to a public liability claim? YESNO

If yes, please provide details

19) Have you previously been insured for public/products liability?YESNO

If yes, please advise name of Insurer ?

20) Will your activities include the use of any of the following
Registered motor vehicles :
YESNO

Watercraft :
YESNO

Aircraft or hovercraft :
YESNO

21) Will you be directly responsible for the supply and set up of staging systems ?YESNO

22) Will you be conducting any rigging activities which require a rigger’s ticket ?YESNO


ONLY COMPLETE THIS SECTION IF YOU CONDUCT PERFORMING ARTS TUITION

For dance, drama, performing arts tuition, please answer the following:

23) Total number of registered students ?

24) Number of students per class?

25) How many classes per week?

26) How many teachers / supervisors?

27) Do students participate in hazardous, strenuous or physical activities?
YESNO

please describe nature of activities

FOR ALL BANDS, ENTERTAINERS, PERFORMING GROUPS, DANCE & DRAMA SCHOOLS PLEASE ANSWER THE FOLLOWING QUESTIONS:-

28) Number of musicians / performers?

29) Will you hire a venue to stage any or all of your performances?
YESNO

Number of times you will hire a venue during the Insured period

Average attendance per hired venue

30) Please advise estimated total number of performances during annual period?

31) Estimated average attendance at each performance

ONLY COMPLETE THIS SECTION FOR FILM OR VIDEO PRODUCTION ACTIVITIES

32) What type of productions will you be filming?

Feature films :
YESNO

Documentaries :
YESNO

TV productions :
YESNO

Corporate videos :
YESNO

Private & public events or occasions :
YESNO

TV Commercials :
YESNO

Music video :
YESNO

Other productions –please describe

33) If annual cover required, please advise estimated number of productions during next 12 month period?

34) Estimated number of filming days

35) Estimated production budget

For annual period if required $

For one off or short term period $

36) Will your productions involve the use of:

Fire, fireworks, pyrotechnics
YESNO

Stunts or explosions
YESNO

Dangerous activities
YESNO

Aircraft, watercraft or motor vehicles
YESNO

If yes to any of the above please describe:

37) Date of event

38) Location where event is to be held

39) Is the event being held indoors or outdoors? (For larger outdoor events, please provide layout plan of the venue etc.)

40) Is there any temporary seating structures being used?
If yes, please ensure that the contractor responsible for supplying and setting up these structures carries
their own public liability insurance.

YESNO

41) Event times: From To

42) Artists performing (if applicable)

43) If your event is a concert or performance, what style of music or performance is being performed?

44) Estimated ticket price (if applicable)

45) Do you require annual cover for all events staged during annual period?
YESNO

Number of events, concerts or performances to be covered?
(Please supply a separate schedule of events if possible)

46) Estimated attendance at your event / events
(Please provide a total estimate if insuring more than one event)

47) Who will be responsible for security?
(Please ensure that the contracted security company carries their own public liability insurance)

48) Will you be serving, selling or supplying alcoholic beverages at your event?
YESNO

If yes, please advise:-

Who is actually selling or serving the beverages?

Do they carry their own liability insurance for this activity?
YESNO

Who has signed the liquor license?

49) If your event is an exhibition or market, please provide number of stalls?

Will all stall holders or exhibitors carry their own liability insurance?
YESNO

(It will be a policy condition that all stall holders or exhibitors to carry their own public and products liability insurance)

50) What type of products or services do the stall holders or exhibitors sell or display at your event?

DECLARATION

I/We hereby declare that the information provided by me/we in this questionnaire is true and correct and that I/we have read and understand the Important Notices at the start of this questionnaire. I/We also agree that this questionnaire can be used as the proposal of insurance and therefore the basis of the contract of insurance between me/we and the underwriter, if so approved by the underwriter.

(Signature) :
(Date) :
(Name) :
(Position) :

OTHER INSURANCES

We recommend that you consider the following other insurances, which are available, and which may also be pertinent when preparing any contingency or risk management plan. Please contact our office if we may answer any questions or if you require a quotation.

CANCELLATION INSURANCE (including Weather & Non-Appearance)
YESNO

VOLUNTARY WORKERS ACCIDENT INSURANCE
YESNO

WORKERS COMPENSATION (compulsory for all employers)
YESNO

EQUIPMENT INSURANCE (including hired or borrowed items)
YESNO

EVENT ORGANISER’S PROFESSIONAL INDEMNITYINSURANCE
YESNO

OzPrize & Weather Insurance Specialists Pty Limited Corporate Authorised Representative No. 309116 of Warren Saunders Insurance Brokers (Aust) Pty Ltd ((Est.1961) (AFS Lic No 240939 ) Level 2, 29 Albert Avenue, CHATSWOOD NSW 2067 Direct Phone: 61-2- 9785 3413 Fax: 61-2- 9774 5672 Email: admin@ozprize.com.au Web: www.ozprize.com.au