Short Term Productions


Short Term Productions Application

  • If you have any questions about how to fill in this form call (818) 788-1911 to speak to one of our friendly advisors.

  • This application is used to insure a single production with a maximum budget of $1,000,000 and a maximum duration of 60 days within a 60 day consecutive period

  • Required Documents

    The following documents are required to apply for coverage:
    • This application
    • Fraud Statement
    • Estimated Schedule of Productions
    • Stunt Schedule (if any stunts/hazardous activities)
    • Cast Schedule (if cast coverage is required)
    • Cast Medical Certificates (for cast members that require sickness coverage)
    • Animal Schedule (if animal death/injury coverage required)
  • Applicant Information

  • Underwriting Qualification Questions

  • Insurance History

    if Yes, provide details below
  • Policy 1

  • Policy 2

    If yes, provide details below
  • Policy 1

  • Policy 2

  • Productions Details

  • Music Videos Only

  • Key Personnel

    Enter the key personnel: executive producer, producer, director, etc. (at a minimum, either the executive producer or producer must be listed)
  • Executive Producer

  • Producer

  • Director

  • Other Key Personnel 1

  • Other Key Personnel 2

  • Other Key Personnel 3

  • Other Key Personnel 4

  • Other Key Personnel 5

  • Other Key Personnel 6

  • Stunts and/or Hazardous Activities

    (Visit for stunts & categories)
    If yes, the information below is required for each stunt/hazardous activity
  • Animal Coverage

  • Required Attachments for Stunts/Hazardous Activities

    - Detailed synopsis of stunt
    - Resume(s) of stunt coordinator(s)/pyrotechnician(s)
    - If animal coverage (death, illness) is required, include certificate of good health

    - Certain stunts/hazardous activities are ineligible
    - Certain coverages (such as workers compensation) may not be available for productions that include stunts/hazardous activities
  • Coverages

  • Dates of Coverage

  • (12 month coverage term)
  • (12 month coverage term)
  • General Liability Coverage

  • Coverage Limit

  • Deductible

  • Inland Marine Limit

  • Same as Negative Film
  • Covered Person Extension (with Sickness)

    Select limit below
  • Inland Marine Deductible

  • Automobile Limit

  • Automobile Deductible

  • Workers Compensation

  • Excess Liability

  • Workers Compensation Details

    Complete this section only if workers compensation coverage is desired.
  • Payroll Company and Shoot Duration

  • Payroll

  • Production

  • Clerical

  • Sales

  • Editing

  • Photography

  • Officers & Owners (Include/Exclude)

  • Schedule of Officers & Owners

  • Schedule #1

  • Schedule #2

  • Schedule #3

  • Notes

    - Workers Compensation coverage may not be available in all states.
    - Certain production activities may preclude the production from being eligible for workers compensation coverage.
  • Cast Extra Expense

    Complete this section if cast coverage is required
  • Cast Coverage Option

    Select required coverages
    Select required coverages
  • Individuals to be Scheduled

    List individuals to be scheduled
  • Individual #1

  • Individual #2

  • Individual #3

  • Notes

    Individuals that are scheduled must undergo a medical examination and be approved by underwriters in order to receive sickness coverage
  • Animal Death, Illness, Injury

    Complete this section if death, illness and injury coverage is required for any animal(s)
  • Animal #1

  • Notes

    For sickness coverage, a veterinarian certificate of good health is required
  • Additional Comments