Special Event/Competition Quote Request Are you an insurance agent or broker?* Yes No Name of the Event* Event Location Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name (Show Manager/Event Planner)* Contact's Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Actual Date the Event Begins* MM slash DD slash YYYY Actual Date the Event Ends* MM slash DD slash YYYY Website for Event Is this a sanctioned event?* Yes No If "Yes", please list sanctioning group(s) Details about the event you would like to insure*Please be as specific as possibleFurther Description of Event*Select all that apply Gymkhana Horse Show Roping Other If "Other", please list below Do you require coverage for set-up and take-down days?* Yes No If "Yes", what is the first day of set-up? MM slash DD slash YYYY What is last day of take-down? MM slash DD slash YYYY What is the estimated number of Attendees at this event?*(Per Day) What is the estimated Total Gross Receipts?* Which Limit of Liability do you require?* $500,000 $1,000,000 $2,000,000 What is the Maximum Number of Competitors per day?* Does the event require a signed release or waiver from ALL competitors?* Yes No How many years has this event occurred/been in business? Has this event incurred any liability claims within the last 5 years?* Yes No If "Yes", please provide details of claim including date and amount paidDoes the show management, officials, or judges use golf carts or any other off road vehicles that are leased by the show?* Yes No If "Yes", how many vehicles? How are the vehicles used? (e.g., transfer feed, tack, show officials) How did you hear about us*Internet Search (Please specify words searched below)American Kennel ClubFriend/ReferralLinkedInTrade Show (Please specify below)United Kennel ClubOther Club or Organization (Please specify below)Other/Please Specify Details Please list any additional comments Δ