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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© The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries.

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