Equine Clubs & Associations Liability Quote « Horse Insurance with Smith-Embry

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EQUINE CLUBS & ASSOCIATIONS

How did you hear about us?

List of other sources

Name of Club/Organization

Name

Address

City

State

Zip Code

Phone

Fax Number

Contact Preference

Phone

Mail

Location of Operation if different from above address

Address

City

State

Zip Code

Does the Club own, lease or permanantly occupy a facility?

Yes

Does Club rent any premises on a long-term lease?

Yes

Provide full information of any lease premises, including full address.

Number of Club Members

Provide Limit Required

Select Limit Required

$500,000 per occurrence/$1,000,000 annual aggregate

$1,000,000 per occurrence/$2,000,000 annual aggregate

Excess over $1,000,000 required (Provide Limit below)

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED ENTRIES FOR EVENT

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

ADD ANOTHER EVENT

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED SPECTATORS PER DAY

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

ADD ANOTHER EVENT

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED SPECTATORS PER DAY

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

ADD ANOTHER EVENT

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED SPECTATORS PER DAY

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

ADD ANOTHER EVENT

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED SPECTATORS PER DAY

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

Do you currently have an Equine Liability Policy?

Yes

Any prior losses?

Yes

Name of Insurance Company

Expiration date of current policy

Comments / Questions