Theatre Producers Enquiry Form

First Scene Theatre Producers

Please note that the completion and submission of this form does not bind you or us to enter into a contract of insurance. In order to minimise the need for further clarification please answer all questions fully.

You understand that you must make a fair presentation of the risk to us when completing this form and at inception, renewal and whenever you request changes to your policy. This means that you must tell us about all facts and circumstances which may be material to the risks covered by the policy in a clear and accessible manner and must not misrepresent any material facts. A material fact is one which would influence our acceptance or assessment of the risk.

If you have any doubt about facts considered material, it is in your interest to disclose them. If you do not make a fair presentation of the risk the policy may be avoided, written on different terms or a higher premium may be charged, depending on the circumstances of the failure to present the risk fairly.

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Your Details

Name of Insured(Required)

Business Description(Required)

Name of Production(Required)

Type of Production (i.e. Musical, Play, Opera, Ballet, Dance)(Required)

Contact Name(Required)

Full Name

Address and Postcode(Required)

Telephone Number(Required)

Email Address(Required)

Website address

Employers Liability Tracing Office (ELTO) number (also known as Employer PAYE reference)

Insurance Requirements

Date Insurance to Commence (to include audition period and rehearsals)(Required)

DD slash MM slash YYYY

Date Insurance is to End(Required)

DD slash MM slash YYYY

Comments

Annual / Short Period

Annual

Short Period

If annual cover, how many weeks of the year will you work?(Required)

Will any performances be taking place outdoors?(Required)

Yes

Renewal Date (if any)

DD slash MM slash YYYY

Will you be undertaking performances with children or vulnerable adults?(Required)

Yes

If yes, have the appropriate DBS Checks been carried out(Required)

Yes

Any hazardous activities including, but not limited to, trapeze, circus acts, animal acts, firearms, work at height, flying, or pyrotechnics?(Required)

Yes

Please provide details of Hazardous activities(Required)

Is this a tour?(Required)

Yes

Please select how many venues you will be touring to(Required)

Will the production go outside the UK?(Required)

Yes

If so, where and how long?(Required)

Details of any US assets

Are you a member of UK Theatre?

Yes

Current Insurers / Premium, if applicable

Your Production Insurance Needs

Cover Type and Summary

Please choose what cover you would like to add from the following

All Risks(Required)

Insures production property in any theatre, rehearsal studio, approved store, or in transit within the UK for “All Risks” cover, as defined in the policy document

Yes

Money(Required)

Insures loss of money from the insured premises, or in transit up to defined limits, including personal accident and personal effects cover resulting from assault.

Yes

Employers’ Liability(Required)

This cover is a legal requirement for businesses with employees. It insures legal liability for death or injury to employees suffered in the course of their employment.

Yes

Public Liability(Required)

Insures legal liability for injury to third parties or for loss or damage to third party property, arising from the activities of the insured business. This excludes liability caused by products, goods sold or supplied.

Yes

Your Specific Risk Requirements

Please provide sums insured and/or limits required. Please refer to the policy wording and schedule for full details of cover provided.

Section A – All Risks

Scenery Props and Wardrobe (including non-electronic musical instruments)(Required)

Sound Lights & Video (including electronic musical instruments)(Required)

Artistes Property used in the production(Required)

Laptops(Required)

Office Contents(Required)

Merchandise(Required)

Other property – i.e. portable electronic equipment, tools, cameras etc. - please specify:

Do you require Continuing Hire Charges?(Required)

Yes

Do you require storage cover?(Required)

Yes

If so, please give address, construction and security details of the store(Required)

Do you require Terrorism cover for the equipment whilst in Mainland UK?(Required)

Yes

Do you require Terrorism cover for the equipment (including Riot & Civil Commotion) outside mainland UK?(Required)

Yes

Section B – Money

Money in Transit(Required)

Money In Safe(Required)

Petty cash(Required)

Details and location of safe(Required)

Malicious Attack : Capital Benefits £40,000 / £400 per week payable for 104 weeks

Section C – Employers Liability

Category of Employee / Number of employees / Wages / Fees (£) (In total during the period of insurance including rehearsal and performing)

Category of employee

Number of employees

Wages/Fees (£)

(In total during the period of insurance including rehearsal and performing)

Some examples of Hazardous Acts are any acts involving flying, flames, firearms, explosives, trapeze, animal acts etc.

Hazardous (see below) or USA performers

Hazardous (see below) or USA performers: Number of employees

Hazardous (see below) or USA performers: Wages/Fees (£) (In total during the period of insurance including rehearsal and performing)

Non-Hazardous Cast

Hazardous (see below) or USA performers: Number of employees

Hazardous (see below) or USA performers: Wages/Fees (£) (In total during the period of insurance including rehearsal and performing)

Crew

Crew: Number of employees

Crew: Wages/Fees (£) (In total during the period of insurance including rehearsal and performing)

Orchestra

Orchestra: Number of employees

Orchestra: Wages/Fees (£) (In total during the period of insurance including rehearsal and performing)

Clerical and managerial

Clerical and managerial: Number of employees

Clerical and managerial: Wages/Fees (£) (In total during the period of insurance including rehearsal and performing)

Children

Children: Number of employees

Children: Wages/Fees (£) (In total during the period of insurance including rehearsal and performing)

Do you employ foreign performers?(Required)

Yes

Are they contracted on a UK Contract?(Required)

Yes

Are they American/Canadian?(Required)

Yes

Do you employ any Woodworking Machinists?(Required)

Yes

If so, please specify:(Required)

Please provide details of any Hazardous Acts. Examples of Hazardous Acts include flying, flames, firearms, explosives, trapeze, animal acts(Required)

Section D – Public Liability

Limit of indemnity: £5m, £10m, Other(Required)

Other please specify in £:(Required)

Regular Tours Overseas(Required)

Yes

Any other Work Away Overseas(Required)

Yes

Detail use of any firearms, swords, explosives, animals or other hazardous acts(Required)

Other Insurances

This is not meant to be an exhaustive list. If there is something particular you are concerned about which is not mentioned below or if you need further explanation about any of the below, please call the office to discuss.

Do you require a quotation for:

Excess of Loss – Public / Products Liability(Required)

Yes

Excess of Loss – Employers Liability(Required)

Yes

Group Personal Accident(Required)

Yes

Political Violence(Required)

Yes

Medical Expenses following Personal Accident(Required)

Yes

Cancellation & Non Appearance(Required)

Yes

Business Interruption(Required)

Yes

Engineering Inspection(Required)

Yes

Management Liability (Directors & Officers, Entity, Employment Practice Liability)(Required)

Yes

Charity Trustees(Required)

Yes

Professional Indemnity(Required)

Yes

Travel Insurance(Required)

Yes

Marine Transit Insurance(Required)

Yes

Healthcare for Foreign Performers in the UK(Required)

Yes

US Liability Insurance(Required)

Yes

Cyber(Required)

Yes

Crime(Required)

Yes

Commercial Legal Expenses(Required)

Yes

This is not designed to be an exhaustive list of Insurances. If there is something particular you are concerned about which is not mentioned above, or if you need further explanation about any of the above, please call the office to discuss.

Your Loss & Claims Details

Please provide details of any losses or potential claims that this or previous productions have experienced in the last 3 years.

Have you had a loss or claim in the last 3 years?

Yes

Loss/Claims details(Required)

Please list the details of all your losses/claims below. List each claim/loss as a new row. Rows can be added using the +

Type of claim

Details

Outstanding

Paid

Please check this box to confirm that you have no losses or potential claims in the last 3 years(Required)

I confirm I have no losses or potential claims in the last 3 years

Declaration

Have you, any owner, director, business partner, principal proposer or family member in the business:

Ever had a request for Insurance cover refused or had special Insurance Policy terms imposed? Policy voided, withdrawn or suspended?(Required)

Yes

Ever been declared bankrupt or insolvent or been involved in any company that went into receivership, administration or liquidation, or disqualified from being a company director? Or been the subject of a winding up order, or voluntary agreement with creditors?(Required)

Yes

Ever been convicted or charged (but not yet tried) with a criminal offence?(Required)

Yes

Ever been given any County Court Judgements?(Required)

Yes

If Yes, provide details here(Required)

Consent(Required)

I/we shall inform you of any material alteration to those facts and/or the information supplied before completion of the contract of insurance.

Consent(Required)

I/we declare that the statement and particulars in this proposal are true and complete. I/we have made a fair presentation of the risk and have not misrepresented or suppressed any material facts after full enquiry of relevant parties within my/our organisation. I/we agree to the contract of insurance being prepared using the information I/we have supplied in this form, along with any associated information I/we have supplied.

Signature(Required)

Date signed(Required)

DD slash MM slash YYYY

Please note that completion of this form does not constitute a contract or inception of any cover or liability attaching to insurers. No cover shall be effective without written confirmation of such cover from the company.

Please do not hesitate to contact Gordon & Co if you require clarification on any of the above or wish to disclose anything further.

Name

This field is for validation purposes and should be left unchanged.

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