Philly Fringe Insurance Form | Domenick & Associates: Specialty Insurance Brokers

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Philadelphia Fringe Festival Insurance 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
$3,000,000 General Aggregate Limit
$100,000 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

Contact Name

Name Of Performing Group

Address

City

State

Zip

Phone Number

Email Address

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:

How many shows will be performed?

1 to 5 shows. ($120.00 plus $6.00 admin fee)
6 to 14 shows. ($172.00 plus $8.00 admin fee)
15+ shows. ($222.00 plus $12.00 admin fee)

Payment Information

Sub-Total $

Processing Fee $

Final Total $

Credit card number

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

CVV number

Expiration Date

Name on card

Please note your payment receipt will be accepted as valid evidence of insurance by the Festival and should be uploaded to the Festival site. Insurance certificates will be issued at a later date prior to September 3rd and can be used as proof for venues requiring such evidence. If you have questions, please contact Chris Garrity at our office: cgarrity@domenick.com

Merchant Services

Receipt

Please provide email address below and we will email a receipt which can be used as proof of insurance for the Fringe Festival.

Receipt will be mailed to:

Domenick and Associates: Specialty Insurance Brokers

Philadelphia Fringe Festival Insurance Form

Coverage provided