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CGA Associates Special Event / Weather / Wedding / Insurance Application Form
For the fastest and most accurate insurance quote, please provide as much information possible in the form below. This information will be kept confidential and will be used for quote purposes only!

Submitting Information

Business Name:
Contact Name:
Street Address:
City:	State: ZIP:
County:	Email:
Business Phone:	Fax:

Applicant Information Section

First Name:
Last Name:
Business Name:
Mailing Address:
Mailing City:	State: ZIP:
Email:
Phone:	Fax:

Underwriting Information
Event Address:
Event City:	State: ZIP:
Please describe the Special Event:
Please describe your Experience for Past Special Events:
Number of days the Event will run:
What date do you expect the Event will Begin:
Estimated Attendance Per Day:
Total Estimated Participants:
What is the Maximum Capacity of the Event location:
Total Gross Receipts for the Event:
Any Celebrities To Be Present?	yes no
Type Of Seating:
Crowd Control & Protection:
Will Bleachers Or Platforms Be Used?	yes no
If Yes, Are They:
Does The Special Event Involve Fireworks?	yes no
Does The Special Event Involve Amusement Rides?	yes no
Does The Special Event Involve Food Sales?	yes no
Does The Special Event Involve Alcoholic Beverage Sales?	yes no
Is This A Sponsored Event?	yes no
Business License Number, If Applicable:
License Type, If Applicable:
Years of Experience:
How Many Years Have You Operated Under This Business Name?
Have You Uses Any Other Business Name During The Past 5 Years?	yes no
Losses-Claims In The Past 5 Years:
If Yes, Description, Type & Amount Of each loss-claim
Liability Limits Requested:

Additional Comments:

Please give any additional comments about the coverage you desire: