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1Policy Holder Information
2Policy Term
3Aditional Information & Digital Signature
  • Policy Holder Information

  • (As it should appear on insurance policy)
  • Please describe all claims including date, payout, and loss details.
  • Policy Term

  • Short-Term Coverage: Policy Terms 1 Day to 11 Months - Rented Equipment Coverage Only (No Automobiles)
  • (Replacement Value, including sales tax, of all equipment being rented)
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • (If you have a covered claim, this coverage reimburses your rental company for loss of rental income during your claim handling. This coverage has a 72 hour waiting period from the time the claim is reported in writing to the insurance agent or carrier.)
  • Annual Coverage: Policy Term 12 Months - All Eligible Coverages and Options Available (No Automobiles)
  • 1. Please complete. At least one limit is required below

  • Equipment Type
    Replacement Value (Include sales tax) If none, enter 0
    Description of Equipment (If none, please type "NA")
  • Cameras, camera equipment, sound, audio visual, lighting and grip equipment, communications equipment, portable electric equipment, editing and projection equipment, office personal property, generators, mechanical effects equipment, props, sets, wardrobe, event equipment, theatrical equipment, computer equipment including desktops,laptops and monitors, and all similar personal property and related production and entertainment equipment.
  • Sporting goods and equipment, gym and fitness equipment, business personal property, tenant improvements, sport event property, race timing machines, racing chips, banners, office personal property, ROTC related equipment, and any related Sports & Recreational equipment.
  • Fixtures, alterations, installations, or additions that become part of a building that you do not own and cannot be legally removed. The tenant improvements and betterments were paid by you and had them installed or personally installed. This does not cover any landlord improvements to the rented space.
  • Office Furniture, lockers, rugs, lamps, telephones any other similar business personal property.
  • Musical Instruments, sound equipment, vintage musical instruments, similar personal property, office personal property, and other related musical equipment.
  • Any of the above equipment classes rented for use not including tenant betterments and improvements.
  • 2.

  • 3.

  • (this covers your equipment if the person/company renting or borrowing your equipment never returns it)
  • 4.

  • 5.

  • If you have a covered claim, this coverage reimburses your rental fees for equipment rented to continue your business operations.
  • 6.

  • If you have a covered claim, this coverage reimburses your rental company for loss of rental income during your claim handling. This coverage has a 72 hour time deductible from the time the claim is reported in writing to the insurance agent or carrier.
  • 7.

  • This coverage is a separate limit for work related tools and clothing, such as work uniforms
  • 8.

  • This covers exterior or interior plate glass installed by either you or your landlord at your business location.
  • 9.

  • This covers the loss of business income and extra expenses as a result of a covered claim. This does NOT include 'rental value' which is loss of rental income your landlord incurs. This optional coverage is tied to the scheduled location only, which means the claim has to occur at the scheduled location.
  • Please enter a number less than or equal to 50000.
  • Please schedule the location(s) for the requested Business Income Coverage (description, location address, city, state, zip):
  • A business continuation plan would be a written document with a plan of action to get your business up and running to minimize down time based on the following 4 key elements. 1-Office Space. 2-Power for this Space. 3-Connectivity (internet/phone). 4-Technology/Hardware Systems.
  • 10. Locked Vehicle Warranty

  • This covers exterior or interior plate glass installed by either you or your landlord at your business location.
  • Aditional Information

  • Disclaimers & Signature

    • I understand that this quote is for equipment coverage and does not apply to vehicles, liability insurance, or workers compensation coverage.
    • I understand that if I take my equipment to the country of Mexico, there is an automatic sub-limit (cap of coverage) of $25,000 total.
    • I understand that coverage is worldwide except for countries with US Sanctions.
    • I Understand that minimum premium is fully earned at policy inception.
    • I understand that if the policy is cancelled, all minimum premium is fully earned and will not be refunded.
    • I understand that my policy has a LOCKED VEHICLE WARRANTY. This means that there is no coverage for theft from an UNLOCKED vehicle unless I elect to remove this warranty for an additional 10% of my premium.
    • I have reviewed and understand the above statements. I certify that the information provided is true and accurate to the best of my knowledge. I understand that providing false information may affect my coverage and even void coverage in the event of a claim.
  • This field is for validation purposes and should be left unchanged.

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Anthony Insurance Services

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