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408-286-1111
408-997-7890
CA Lic#
0697055
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CEO Zain Jeewanjee
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Short Term Production
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If you have any questions call us at
408.286.1111
for help or fax at
408.997.7890
Contact Information
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Qualification Questions
Any: Stunts,Pyrotechnics, Aircraft, Boats, Animals, Race, Tracks, Race Courses, Helicopters, Motorbikes, Snowmobiles, Blanks, Squibs, Guns, Rap Music?
Yes
No
Is coverage required outside of the U.S. and Canada?
Yes
No
Any prior production with any losses of any kind?
Yes
No
Production Details
Type of Production:
Title of Production:
Budget (Gross Production Cost):
Brief Description/Synopsis of Shoot:
Cities and States of Shooting Locations:
Coverage Start Date:
Coverage End Date:
For Music Vedios Only
Type of Music:
Music Decade:
Artist Name:
Coverage Options
Property
Rented Equipment Limit:
$
Props, Sets, Wardrobe Limit:
$
Negative Film/Faulty Stock:
Extra Expense:
Third Party Property Damage:
None
250,000
500,000
1,000,000
General Liability
Occurance/Aggregate Limit:
$1,000,000 / $1,000,000
$1,000,000 / $2,000,000
$2,000,000 / $2,000,000
$3,000,000 / $3,000,000
$4,000,000 / $4,000,000
$5,000,000 / $5,000,000
Blanket Additional Inusred/Certificates of Insurance:
Automatically Included
City Certificates:
Include
Exclude
Waiver of Subrogation:
Include
Exclude
Hired and Non-Owned Auto
Liability:
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
Physical Damage $125,000 per vehicle, $500,000 aggregate
Include
Exclude
Workers Compensation
Workers Comp required by SAG?:
Yes
No
Number of Cast:
Number of Crew:
Number of Volunteers:
Payroll W-2:
Payroll 1099:
Payroll Deffered:
Payroll Other:
Payroll Company Name(if any):
Officer 1 Name and Title:
(Name) (Title)
Officer 2 Name and Title:
(Name) (Title)
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Copyright 2005-2015 Jeewanjee Insurance Agency All rights reserved
California Lic # 0697055
1494 Hamilton Ave #101, San Jose, CA 95125