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  • Policyholder Information

  • The name of the business/organization purchasing the insurance; as it will appear on the policy documents and/or other contract or rental agreements.
  • Event Details

  • Desired coverage date (including setup and tear down):
  • MM slash DD slash YYYY
  • to
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • :
  • to
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  • Please provide a detailed list of all activities to be held or what will take place for the duration of your event to ensure your event is quoted properly and returned promptly.
  • Insurance Details

    All policies are issued with a $1,000,000 per occurrence.
  • Prior Insurance Experience

    Please fax, mail or email premium and loss experience for the past 5 years to (720) 836-6399.
  • Please fax to (720) 836-6399, mail, or email all Lease and Hold Harmless Agreements, brochures of the event and a diagram of location(s) to be used.
  • Additional Insured

  • Additional Information & Digital Signature

  • Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly provides false information in an application for insurance may be guilty of a crime and may be subject to civil fines and criminal penalties. I certify that the above information is true and coverage is not in force until accepted by Anthony Insurance Services, Inc. Coverage is subject to the receipt of payment of the required premium by Anthony Insurance Services, Inc.

    Coverage will begin on the date of acceptance or on the date requested, whichever is later. I understand that the premium is fully earned upon policy inception.
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Anthony Insurance Services

Toll Free: (877) 811-2271
Fax: (720) 836-6399

For dance, yoga, gymnastics, or fitness insurance, see our sister website Dance Studio Insurance.

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