Equipment Floater Application

Contact Information
Name of Insured:
Entity Type:
Street Address:
City:
State:
Zip:
Contact Person:
Phone:
Fax:
Email:
Qualification Questions
Any equipment losses in the past 5 years?	Yes No
Principally involved in pornography production?	Yes No
Any coverage cancelled or denied in the past 3 years?	Yes No
Do you currently have an equipment floater policy through Fireman's Fund McGee Marine Underwriters?	Yes No
Are you primarily in the business of renting equipment to others?	Yes No
Additional Information
Years of Industry Experience:
Description of Business Operations:
Address of primary location (if different to mailing address above):
If scheduled equipment is over $100,000 advise name of central station alarm company at primary location:
Prior Coverage
Carrier Name:
Policy Number:
Expiration Date:
Coverage Options
Effective Date of Coverage:
Category	Limit to Insure
Scheduled Equipment
Editing/Post Production Equipment
Recording/Studio Equipment
Sound/Location Recording Equipment
Musical Instruments/Band Euipqment
Camera/Production Equipment
P.A./Sound Reinforcement Equipment
Office Contents:
Theatrical Equipment
Unscheduled Equipment
Rented Equipment
Unscheduled Equipment ($10,000 maximum)
Rental Reimbursement (Daily Limit)	$500 $1,000 $1,500 $2,000 $2,500
Please note that once coverage is bound and the certificates have been issued the policy cannot be canceled.