PARADE / FESTIVAL LIABILITY APPLICATION

CLAIMS – MADE

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 (LIABILITY COVERAGE WILL BE RESTRICTED TO THE DIRECT BODILY INJURY

  / PROPERTY DAMAGE CAUSED BY THE PARADE PARTICIPANTS ONLY

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NOTE: PREMISES LIABILITY COVERAGE IS NOT AUTOMATICALLY INCLUDED.

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AGENCY: LESTER KALMANSON AGENCY INC. &/OR MITCHEL KALMANSON

        P.O. BOX 940008 

        MAITLAND, FLORIDA 32794-0008 USA

        PH) 407-645-5000 / FAX. 407-645-2810  WWW.LKALMANSON.COM

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IMPORTANT:   THIS IS NOT A BINDER.

INCOMPLETE & UNSIGNED APPLICATIONS ARE NOT ACCEPTABLE.

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1)  NAME OF INSURED:

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2)  MAILING ADDRESS:

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3)  

   IF OTHER:

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4)  PHYSICAL LOCATION WHERE PARADE(S)/FESTIVAL(S) IS TO BE HELD:

     A) SINGLE SITE: 

     B) SPREAD AROUND CITY: 

     C) SQUARE BLOCKS OR ACRES:

     D) OTHER LOCATION INFORMATION:

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5)  WORK:   HOME:

    CELL:   EMAIL:

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6)  REQUESTED LIMITS OF LIABILITY (PER OCC./AGG):    

    IF OTHER:                                        

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7)  DEDUCTIBLE (PER CLAIM BI/PD INCL. L.A.E.):

   IF OTHER:       

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8)  ADDITIONAL INSURED(S) AND THEIR INTEREST:

   

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9)  DESCRIPTION OF PARADE / FESTIVAL:

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10) NUMBER OF FLOATS:

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11) DATE(S) OF EVENT:

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12) BEGINNING AND ENDING HOURS: TO

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13) LOCATION(S) OF PARADE / FESTIVAL (CITY & STATE):

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14) ESTIMATED SPECTATOR ATTENDANCE:

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15) HOW MANY TIMES HAS THIS EVENT BEEN HELD AT THIS LOCATION:

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16) WHAT IS YOUR PAST EXPERIENCE ORGANIZING THIS TYPE OF EVENT:     

   

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17) PRESENT OR PREVIOUS INSURANCE CARRIER:

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18) A) PREVIOUS LIABILITY LIMITS:

    B) PREVIOUS DEDUCTIBLE:

    C) PREVIOUS LOSSES:

       EXPLAIN IN DETAIL:

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19) HAS ANY INSURANCE CARRIER CANCELLED OR REFUSED COVERAGE?

    IF YES, EXPLAIN IN DETAIL:

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20) WHAT ANIMALS, IF ANY, WILL BE IN THE PARADE:

    GIVE TYPE, DESCRIPTION, AND NUMBER:

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21) ARE THE ANIMALS INSURED FOR LIABILITY:

    A) IF SO, FOR HOW MUCH:

    B) PROVIDE CERTIFICATE(S) OF INSURANCE ON EACH ANIMAL.

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22) DESCRIBE SECURITY PROTECTION (NUMBER AND TYPE):

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23) WHAT CONCESSIONS WILL BE SOLD:

A)     PROVIDE CERTIFICATE(S) OF INSURANCE FROM VENDORS LISTING YOU

AS AN ADDITIONAL INSURED.

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24) WILL ALCOHOLIC BEVERAGES BE SERVED:

    DESCRIBE WHICH TYPE (WINE, BEER, HARD LIQUOR):

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25) WILL ANY OTHER ADDITIONAL UNDERLYING COVERAGE BE PROVIDED:

    IF YES, DESCRIBE:

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26) CHECK ADDITIONAL QUOTES NEEDED:

RAIN

NO SHOW

D & O

PD

OTHER:

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27) ATTACH (MAIL / FAX) A DIAGRAM OF LOCATION: PARADE ROUTE FROM BEGINNING TO END

    &/OR FESTIVAL MAP.

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28) WILL ROAD BE CLOSED IN BOTH DIRECTIONS:

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29) ARE SOUVENIRS OR OTHER ITEMS ALLOWED TO BE THROWN INTO THE CROWD?

IF YES, DESCRIBE:

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30)  NOTE: A) NO PERSONAL CHECKS ACCEPTED (MONEY ORDER OR CASHIERS CHECK ONLY)

 

        B) CREDIT CARD(S) (MASTERCARD AND/OR VISA) ACCEPTED

 

           C) POLICY IS FULLY EARNED AT INCEPTION, UNLESS OTHERWISE STATED.

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31) NO LIABILITY COVERAGE AFFORDED FOR ANY COMMERCIAL OPERATION(S) &/OR ACTIVITIES &/OR ANY UNSCHEDULED ANIMAL(S) UNLESS SPECIFICALLY ENDORSED HERETO AND AN ADDITIONAL PREMIUM CHARGE IS MADE AND PAID BY THE ASSURED.

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32) REMARKS (IF ANY):

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ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE.

 

I UNDERSTAND AND AGREE THAT ANY MISSTATEMENT OF WARRANTY OF FACT ON THIS APPLICATION SHALL BE CONSIDERED A VIOLATION OF COVERAGE AFFORDED UNDER ANY POLICY ISSUED ON THE BASIS OF THIS APPLICATION. (THIS APPLICATION WILL BECOME PART OF ANY POLICY ISSUED AS A RESULT OF ITS SUBMISSION.)

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SPECIFIC COMMUNICABLE DISEASES

&/OR INFECTION(S) EXCLUSION ENDORSEMENT

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IN CONSIDERATION OF THE PREMIUM CHARGED, IT IS HEREBY AGREED AND UNDERSTOOD THAT THE POLICY IS AMENDED AS FOLLOWS:

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THIS LIABILITY INSURANCE DOES NOT APPLY TO ANY "BODILY INJURY", &/OR "PERSONAL INJURY" &/OR ANY MEDICAL PAYMENTS (IF AFFORDED) &/OR ANY LEGAL DEFENSES ARISING OUT OF ANY CLAIM(S), ACCUSATION(S), &/OR CHARGE(S) BROUGHT BY AND/OR AGAINST ANY INSURED(S) FOR ACTUAL AND/OR ALLEGED DAMAGE(S) AND/OR INJURIES ARISING OUT OF ANY COMMUNICABLE DISEASE(S) &/OR INFECTION(S), INCLUDING E-COLI INFECTION &/OR BACTERIA, NO MATTER HOW TRANSMITTED, BY ANY (NAMED) INSURED'S &/OR IT’S EMPLOYEES &/OR ANY OF THEIR ANIMAL / SPECIES, INCLUDING BUT NOT LIMITED TO ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) AND/OR ANY OTHER COMMUNICABLE DISEASE(S) AND/OR INFECTION(S) &/OR BACTERIA.

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CONDITION: IT IS FURTHER AGREED AND UNDERSTOOD THAT THIS SPECIFIC COMMUNICABLE / INFECTIOUS DISEASE EXCLUSION ENDORSEMENT WOULD APPLY TO ANY AND ALL CLAIMANT(S) WHETHER INDIVIDUALLY &/OR AS A CLASS MEMBER OF ANY CLASS ACTION, LITIGATION.

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THE NAMED INSURED UNDERSTANDS AND AGREES TO THE ABOVE CONDITIONS OF THIS POLICY AND ACCEPTS THESE RESTRICTIONS BY SIGNING AS FOLLOWS:

PLEASE INITIAL AND DATE TO ACCEPT TERMS OF APPLICATION (REQUIRED TO PROCESS APPLICATION):

INITIAL     DATE


AFTER SUBMITTING YOUR ONLINE APPLICATION:

PLEASE DOWNLOAD, PRINT, AND SIGN THE "PARADE LIABILITY" AND "TERRORISM" SIGNATURE FORMS

THESE FORMS REQUIRE WET SIGNATURES AND MUST BE RECEIVED VIA MAIL TO PROCESS THE APPLICATION


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