Tenant User Liability Insurance Application
700 N. Central Avenue, 8th Floor
Glendale, CA 91203
Phone: 818.409.4087
Fax: 866.308.3217
smcguirl@ |385 Washington Street, SB04G
Saint Paul, MN 55102
Phone: 651.310.2156
Fax: 651.310.8119
flothenb@ |485 Lexington Avenue, Suite 400
New York, NY 10017
Phone: 917.778.6461
Fax: 917.778.7007
gheard@ | |Coverage provided by St. Paul Fire & Marine Insurance Company
Please complete this application, in addition to Acord 125 and Acord 126, and send all attachments.
|Agent/Broker: | |Date of Application | |
|Address: | |
|Contact: | |Telephone Number: | |
|Email: | |Fax Number: | |
This application is to be completed by the venue/facility requesting liability coverage for their tenant-users.
APPLICANT INFORMATION
|1. |Name of applicant: | |
|2. |Address: | |
|3. |In business under present management since: | |
|4. |Website address: | |
Venue Details
|5. |Name of venue/facility: | |
|6. |Address of venue/facility: | |
|7. |Type of facility: | Theatre | Sports arena | Stadium |
| | | Coliseum | Convention facility | Amphitheater |
| | | Shed | Other (describe) | |
|8. |Buildings |Year built: | |Construction: | |
|9. |Venue is an: | Indoor facility Outdoor facility |
|10. |Seating capacity |Permanent seating | |Temporary seating | |Maximum | |
|11. |Is there a “tenant-user” policy in place now? | Yes No |
| |If yes, have there been any losses? Attach loss runs | Yes No |
|12. |Do you provide in-house security? | Yes No |
|13. |Do you hire outside security? | Yes No |
| |If yes, do you require certificates of insurance and to be named as an additional insured under the security company’s policy? | Yes No |
|14. |Is alcohol ever served at any of the events? | Yes No |
| |a) If yes, who is responsible for providing liquor liability? | Facility Tenant User |
| |b) If “tenant-user” responsible, attach details explaining your requirements of the tenant-user. |
|15. |Are ushers provided? | Yes No |
|16. |Will there be food and/or drinks served? | Yes No |
| |a) If yes, who is providing? | Applicant Venue |
| |b) If applicant is providing, is there certificate of insurance provided? | Yes No |
| |c) Limits: | |Insurer | | |
|17. |Do you require all athletic participants to provide certificates of Insurance naming the facility as an additional insured? | Yes No |
|18. |Insured contact information: |
| | |Name |Phone |
| |Your loss control manager | | |
| |Your general manager | | |
| |Audit contact | | |
| |Accounts/business manager | | |
RATING INFORMATION - PERFORMER OR EVENT
|Type of events |Number of admissions per event |
|– see below for eligible classes | |
|Enter the number of events in the column for the admissions per |1-100 |101-500 |501-1,500 |1,501-3,000 |3,001-5,000 |5,001-10,000|Over 10,000 |
|event | | | | | | | |
|TULIP Class 1 |# of Events | |
|Vendors or concessionaires – food and beverage |Annual number | |
|Vendors or concessionaires - non-food sales and demos |Annual number | |
|(excluding products liability) | | |
Events move than 10,000 admissions (attach separate schedule if more room is needed):
|# |List name of event and date(s) below |TULIP Class 1 |TULIP Class 2 |Promoter Class |Promoter Class |Estimated number of admissions for|
| | | | |1 |2 |event |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
See next page for Hazard Classes
HAZARD CLASSES
TULIP Class 1
Antique shows
Art festivals
Art shows
Auctions
Auto shows
Award presentations
Banquets
Bazaars
Beauty pageants
Bingo games
Boat shows
Body building contests (excluding participants)
Business meetings
Business shows
Chambers of commerce events
Charity benefits, Auctions and sales
Civic clubs and group meetings
Consumer shows
Conventions in buildings
(excluding participants)
Craft shows
Dance shows
Debutante balls
Exhibitions (lessor ushered)
Exhibits in buildings
Expositions – capacity
Fashion shows
Fishing events
Flower shows
Garden shows
Graduations
Garden shows
Gymnastic competitions
Home shows
Housing shows
Ice skating shows
Instructional classes (non-mechanical)
Ladies club events
Lectures
Lounge acts
Luncheons
Meetings indoors – other than mobile home shows
Union
Organized sight-seeing Tours
Outings
Pageants
Parties
Proms
RV shows
Scouting jamborees
Seminars
Social gatherings
Social receptions
Speaking engagements
Teleconferences
Telethons
Trade shows in buildings
TULIP Class 2
Athletic games – non professional
Animal shows (excluding participants)
Bicycle rallies (excluding participants)
Block parties/street closures (excluding participants)
Beaches
Dog shows
Evangelistic meetings
Meetings (non union) – Outdoors
Old-timers events
(excluding participants)
Parades (under 500 spectators)
Picnics – without pools or lakes
Recreational events (excluding participants)
Religious assemblies
Reunions
Rummage sales
PROMOTER Class 1
Big band
Chamber music
Classical
Easy listening
Operas
Orchestras
Symphonies
PROMOTER Class 2
Comedy shows
Folk
Jazz
Religious
Rock
Soft rock
IMPORTANT
• Attach copies of all lease and hold harmless agreements
• Attach a diagram of venue
• Hard copy of loss runs
**SPECIAL EXPOSURES - The following exposures are excluded and must be submitted to the company in advance for approval.
Animals/creatures
Professional sporting events
Pyrotechnics/fireworks
Mechanical rides/stunts
Vehicle races/competitions
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