Specialty Insurance Agency Performers of the us & Vendors of the us



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Specialty Insurance Agency

Performers of the US & Vendors of the US



P. O. Box 24

New Richmond, WI 54017-0024

Fax: 715-246-4257

Phone 715-246-8908

Websites: www.specialtyinsuranceagency.com


Dear Entertainer,

Thank you for your interest in our commercial general liability policy. The following information pertains to the policy & our services.


The Performers of the U.S. insurance program is designed for the individual who is entertaining the public. The policy provides protection for bodily injury or property damage to others during your performance. This application provides a brief outline of coverage. Coverage is subject to all terms, conditions and exclusions stated in the insurance policy.
Operations Not Eligible:

Fireworks, pyrotechnic devices, animals, mammals, fowl, athletic participation, your business employees or subcontractors, trackless trains, moonwalks, jump houses, or other amusement rides and attractions, hypnotists doing the “human bridge”. Magician’s are now approved to use a rabbit &/or dove during their performance.


The 2013 – 2014 shared policy limits of coverage for all members are as follows:

Each Occurrence $3,000,000 (bodily injury & property damage to others)

Damage to Rented Premises $300,000 (to rented premises)

Medical Expenses $5,000 (emergency medical to others injured by you)

Personal & Advertising Injury $3,000,000 (hurting someone's feelings)

General Aggregate $5,000,000 (the most the policy will pay out during the policy year)

Products – Completed Op. Agg. $5,000,000 (the most the policy will pay out during the policy year)
Other Policy Information:


  • You must have a U.S. mailing address to purchase this policy and the premium must be in U.S. dollars.

  • The policy provides protection for bodily injury or property damage to others during your training & performance in the United States, Canada, & U.S. owned islands.



Carrier


Coverage underwritten by Lexington Insurance Company; a carrier rated A (excellent)

Deductible: Zero



Note: We also offer a troupe discount of $10 per person for groups of 15+ coming in together.

We continue to offer a $10 per person discount for Clowns of America and Society of American Magicians (SAM) members that include their COAI or SAM membership number.


Additional Insured Certificates:

Certificate requests can be requested through the website, faxed to 715-246-4257 or your can snail mail them to us. To request through the website go to:

  • www.specialtyinsuranceagency.com

  • Click on Performer Certificate at the top of the home page.

  • Fill in all the blanks and hit the Email Form button at the bottom of page.

Your request is delivered to a processing location. These requests are normally completed within two to five business days. We ask that you to allow two weeks to process your request in the event that there are complications with required wording.



RETURN THIS PORTION WITH YOUR CHECK.

Annual Premium:  April 25, 2013 to April 25, 2014

 Hypnotists: $260.00 per person (new hypnotists must include safety certificate)

 Fire Performers: $230.00 per person

all other performers $220.00 per person



Reduce Premium Option:  October 25, 2013 to April 25, 2014

Note: This reduced premium option will be processed one week prior to the start date.

 Hypnotists: $190.00 per person (new hypnotists must include safety certificate)

 Fire Performers: $165.00 per person

all other performers $155.00 per person


Reduce Premium Option:  January 25, 2014 to April 25, 2014

Note: This reduced premium option will be processed one week prior to the start date.

 Hypnotists: $150.00 per person (new hypnotists must include safety certificate)

 Fire Performers: $125.00 per person

all other performers $115.00 per person


Reduce Premium Option:  March 25, 2014 to April 25, 2014

Note: This reduced premium option will be processed one week prior to the start date.

 Hypnotists: $90.00 per person (new hypnotists must include safety certificate)

 Fire Performers: $65.00 per person

all other performers $55.00 per person


Additional Option:  Single Event (Limited to 7 Consecutive Days) - Cost: $125.00

List Single Event Dates: ___________________________________________________________________



Make your checks or money orders payable to: Performers of the U.S.

First Name:


M.I.:


Last Name:


Business or Performer Name:


Mailing Address:

City:

State:

Zip Code:

Home Phone:

Work or Cell Phone:

Fax:

Email address:

Description of What You Do (this is what we are insuring you for):



This is an application for membership.  This application provides a brief outline of coverage.  Coverage is subject to all terms, conditions and exclusions stated in the insurance policy

Signature: __________________________________ Date: _______________

 If you will be using an Apple product (MAC, iPhone, iPad) to open PDF files please check the box. We can send your file in a different format to avoid issues opening the PDF files.


Our office hours: Monday – Thursday 10AM – 5PM (Central Time Zone)

We are closed on all weekends & holidays.


If you are sending through UPS or FedEx, our street address is: 2076 170th Street, New Richmond, WI 54017
Thank you for considering Specialty Insurance Agency & Performers of the U.S. for your insurance needs! Have a great year and keep smiling!

Stephanie Weiss

There is no charge for naming a venue where you are working as an additional insured but you do need to submit a written request for a certificate via online through website, fax or mail. Use the space below to request a certificate you need right away.


Additional Insured:

(This is the venue where you are performing that is requiring a certificate in their name.)



Name: Faneuil Hall Marketplace

Attn: Janine Crisostamo

Mailing Address (required): 4 South Market Building, 5th Floor

City: Boston

State: MA

Zip Code: 02109

Additional Insured:

Faneuil Hall Marketplace, Inc., General Growth Properties, Inc., GGP Limited Partnership

Rouse LLC, The Rouse Company Holding, L.P., Faneuil Hall Merchants Association

Fax to: : 617-523-1779


PERFORMERS OF THE U.S.

MEMBERS CODE OF ETHICS

As a member of the Performers of the U.S. association I agree to:

1) Keep my act, performance and behavior in good taste while performing for the public.

2) Protect the audience from harm by complying with the established safety requirements and code of ethics.

3) Hypnotist are required to complete a Safety Class and submit a Certificate of Completion with their initial application. The class does not need to be repeated unless the hypnotist has a claim. If the hypnotist has a claim they must retake the safety course prior to renewing their policy.

4) In the event of a claim, member will complete & submit an Accident Investigation form. Include photos &/or video documentations of the incident for claims handling.

5) Fire performers are encouraged to obtain a permit from the local fire department where you are performing and have safety staff readily available. Keep open containers and fire away from the public at all times.

I agree that, adherence to the membership guidelines promotes professional and safe practices that allow us to continue to be respected and successful performers. I fully understand my responsibilities as a member of the Performers of the U.S. association and I understand that disciplinary action, including cancellation of my membership and loss of insurance coverage, could be taken if I do not follow the rules set forth as an association member. I will contact Performers of the U.S. management with any questions about this policy.

Signature: __________________________________ Date: _______________



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