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Domenick and Associates

artsuranceInsurance Enrollment Form

Please complete the form below for your short-term performing arts insurance.

Coverage provided

Commercial General Liability:
  • $1,000,000 each occurrence Bodily Injury and Property Damage
  • $1,000,000 Personal & Advertising Injury
  • $2,000,000 General Aggregate limit
  • $300,000 Damage to Rented Premises
  • $5,000 Medical Expense

This insurance is good for up to 60 days with a maximum of 1,500 in attendance.

Please Note: Your credit card will be provisionally charged, but coverage cannot be put in force for 2 business days. If for some reason the insurance company denies to issue you a policy, you will be notified and the charges reversed.

If you have any questions, please contact us.

All Fields Required

Contact Information
Performance Information

Performance Name/Brief Description of Performance (insert Guide blurb here):

Performance Location (Name of Venue and Location Address):

Number of Shows/Dates of Shows:

What is the number anticipated for attendance? Your event needs to be less than 1500 individuals.

Policy Start Date for Event:

Policy End Date for Event:

Payment Information
example: xxxx-xxxx-xxxx-xxxx (no spaces)

Merchant Services
Optional Receipt

Would you like a receipt emailed to you? If yes, please provide email address below.

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