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Home Obama care CIGNA Domestic CIGNA International CIGNA Global Plans Sign In Contact Us info@insure123.com 408-286-1111 408-997-7890 CA Lic# 0697055 Or Book a meeting With Mr. Zain   Sign In   User Name11     Password   New User Forgot password? News CEO Zain Jeewanjee Interview on WomenNow TV   Short Term Production Please answer all questions to prevent a delay in processing your quote request. If you have any questions call us at 408.286.1111 for help or fax at 408.997.7890 Contact Information Company Name: Business Entity: -----Entity Type----- Corporation Individual Joint Venture LLC (Limited Liability Company) LLP (Limited Liability Partnership) Non-Profit Partnership Trust Other Proprietorship Communities Company Address:       (street)         (City) ---Select a state--- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming (zip)       Contact Person: Telephone: Fax: Cell Phone: Email Address: 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) Are you a robot?

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