Group Vendor Liability - Anthony Insurance Services

Contact Information
Company Name*
Company Address*
Street Address Address Line 2 City State ZIP Code
Contact Name*
First Last
Email Address*
Show Information
Name Of Show*
Show Dates*
Please list or describe applicable show dates. All policies expire at 12:01 AM on the date of expiration. If you have a 3-day event starting on 4/1/2022 and concluding on 4/3/2022, the desired coverage term would be 4/1/2022 - 4/4/2022. The policy will expire on 4/4/2022 @ 12:01 AM
Policy Start Date*
Enter date the policy to start (includes set up day(s))
Policy End Date*
Enter in the date the policy will expire. Policies expire on the date at 12:01 AM
General Aggregate Limit
Please select the desired Aggregate Limit for the policy. All policies are issued with a $1,000,000 per occurrence limit.
- $1,000,000
- $2,000,000
- $3,000,000
- $4,000,000
- $5,000,000
Venue Information
Venue Name or Location of Event*
Venue Address*
Street Address Address Line 2 City State ZIP Code
Additional Insured
Include relationship of additional insured - i.e. Venue/Landlord/Event Management Company, etc.
List
Please use the + button add multiple insured to list.
Name Street Address City State Zip Relationship
Other Details
Please provide any specific certificate language requests
Email address to receive certificate copies*
Estimated number of total exhibitors*
Estimated number of exhibitors purchasing coverage*
Comments
This field is for validation purposes and should be left unchanged.

Name	Street Address	City	State	Zip	Relationship

Contact Information