The Main Event Special Event Product - USLI

1 888-523-5545. The main Event Special Event Product You can obtain a quote by providing the information in the INSTANT QUOTE section, subject to the remainder provided prior to binding. I. INSTANT QUOTE INFORMATION. Instant Quote is only available for accounts with no losses in the past three years. If there is loss history, please detail the losses below. TYPE OF Event . q Beer garden/Beer tent q Fundraiser q Individual vendor booth q Musical/Theatrical performance q Motor vehicle race/Show q Picnic q Concerts q Competition or shows q Sporting Event /Tournament q Conventions/Trade show/Exhibit q Parade q Wedding/Wedding reception q Festival q Party/Social Event q Other (describe):_____.

2 Name of applicant:_____. (List only one legal and dba name. Do not include etal , etc. or other similar wording in the name.). Describe applicant's role and responsibility in Event :_ _____. _____. Location address: q Same as mailing address City:_____ State:_ _____ Zip:_ _____. Coverage desired: q Commercial general liability and liquor liability q Commercial general liability only q Liquor liability only Limits of coverage desired: _____. FULL SCHEDULE/DESCRIPTION AND PURPOSE OF Event (Attach copy of brochure, website pages and flyer to this application or include details on all activities taking place):_____.

3 _____. Dates of Event : From:_ _____/_____/_____ To:_____/_____/_____. (If one day Event , end date should be the same as start date. Quote will contemplate coverage for events continuing past 12:00 ). Desired coverage date(s): From:_ _____/_____/_____ To:_____/_____/_____. If Event date(s) differs from desired coverage date(s), explain:_ _____. Is set-up and take-down coverage needed for additional dates? q Yes* q No *If Yes, what are the dates and what will this exposure include? _____ *Will there be any heavy machinery used such as bulldozers, backhoes, excavators, or any other types of industrial machinery (small forklifts and light machinery are acceptable)?

4 Q Yes q No Would you like to include a rain date? q Yes q No If Yes, what date?_____ Would you like to include coverage for banners? q Yes q No If Yes, does the banner hang above a major roadway or trail behind an airplane? : q Yes q No Name of additional insured:_____. Mailing address: _____. Additional insured's interest in Event : _____. Would you like to include primary and non-contributory wording? q Yes q No If Yes, please advise how many contracts are needed: Would you like to include waiver of subrogation? q Yes q No If Yes, please advise how many contracts are needed: HISTORY.

5 1. Previous carrier:_____ Policy number:_ _____. 2. Describe any previous losses: General Liability/Liquor Year # of Claims Incured Amounts Description Liability/ Assault + Battery $. $. $. SELA- 12/13 page 1 of 5. II. COMMERCIAL GENERAL LIABILITY. 1. Estimated total attendees per day:_____. If applicant is an individual exhibitor/vendor, what is the estimated attendees per day anticipated to visit their booth?_ _____ 2. Will there be any entertainment? q Yes q No If Yes, describe and include name of performers and acts:_ _____. 3. Will Event feature any of the following: a.

6 Mechanical rides/devices? q Yes q No b. Firearms or fireworks? q Yes q No c. Overnight camping or bonfires? q Yes q No d. Water hazards? q Yes q No If Yes , will attendees be permitted to swim, boat, jet ski or fish? q Yes q No e. Haunted house, hayride or corn maze exposure? q Yes q No f. High profile attendees? q Yes q No If Yes , please list: 4. a. Describe security measures:_____. b. If security is provided by independent contractors, are they required to carry their own insurance? q N/A q Yes q No (For Event specific underwriting questions please see Section IV).

7 III. LIQUOR LIABILITY. LIQUOR LIABILITY (IF COVERAGE IS DESIRED). 1. Hours of Event : From: _____AM/PM_ To:_____AM/PM. a. If hours vary by date, describe:_____. 2. Estimated number of attendees consuming alchohol daily:_____. 3. For this Event , is the applicant acting in the capacity of a hired caterer or bartender? q Yes q No 4. Is the applicant an individual or business that regularly sells, serves or furnishes alcohol? q Yes q No 5. a. Is applicant the sole vendor/server of alcohol at Event ? q Yes q No b. If there are multiple vendors, are all participating alcohol vendors/servers required to carry liquor liability limits for the Event equal to or greater than our applicant?

8 Q Yes q No 6. ill alcohol be dispensed by a professional bartender or server that has taken a formal alcohol W. awareness training course? q Yes q No 7. Will alcohol be sold by applicant? q Yes q No 8. Is BYOB (Bring Your Own Bottle) or self-service of alcohol permitted? q Yes q No IV . Event TYPES. 1. If this is a CONCERT/MUSICAL Event , complete below: a. Name(s) of performer(s):_ _____ Describe type of music:_____. b. Performers are: q Local q National c. Will pyrotechnics be featured? q Yes q No d. Any Special effects? q Yes q No If Yes, describe:_____.

9 5. If this is a PARADE Event , complete below: a. Describe parade route from start to finish: _____. _____. b. Has parade route been approved by local authorities and will route be secured by police? q Yes q No If No, explain: c. Are parade participants permitted to throw souvenirs, candy or other items into the crowd? q Yes q No 6. If this is an ATHLETIC Event , complete below: a. Describe athletic Event :_____. b. q Professional or q Amateur If Professional, list the athletes: _____. c. Is this an off road, trail run, mud run or obstacle Event ?

10 Q Yes q No SELA- 12/13 page 2 of 5. 7. If this is a MOTOR VEHICLE RACE, RODEO, TRACTOR PULL OR TRUCK SHOW, complete below: a. Is the venue designed specifically for this type of activity? q Yes q No b. Are metal or concrete barriers in place to ensure spectator safety? q Yes q No If no, describe: c. Are the barriers permanent? q Yes q No d. How high are the barriers? e. What is the distance between the barriers and spectators? f. Are spectators ever permitted in the pit or infield area? q Yes q No g. If this is a rodeo, are the transfer areas between animal pens and the competition restricted from the general public?