*
2. LOCATION ADDRESS [IF DIFFERENT FROM ABOVE]:
3a, 3b. PHONE, FAX AT THEATRE or GROUP'S OFFICE
4a, 4b, 4c. NAME OF CONTACT PERSON, HOME PHONE, OFFICE PHONE
5. IS GROUP INCORPORATED?
6. 501(c) TAX EXEMPT?:
7. ANNUAL ADMISSIONS [Number of People Who Attend Per Year]:
8a. NUMBER OF SHOWS PER YEAR:
8b. THE NUMBER OF PERFORMANCES:
8c.TOTAL PERFORMANCES ANNUALLY:
9. NUMBER OF MEMBERS:
10. ANNUAL BUDGET:
11. NUMBER OF YEARS IN BUSINESS:
12. IS YOUR GROUP CURRENTLY A MEMBER OF AACT?:
13. EXPLAIN PRODUCTION PROCESS: Where rehearse, Bldg Sets, Perform, Store Costumes, etc.
14a. DO YOU OWN/LEASE ANY AUTO, WATERCRAFT, AIRCRAFT?:
14b. IF YES, EXPLAIN:
15. POLICY HAS GENERAL LIABILITY LIMITS OF$1,000,000 Per Occurence / $2,000,000 Aggregate.
INDICATE HIGHER LIMITS IF NEEDED. Amount entered must be in increments of a million.
16a. DOES YOUR GROUP HOLD SPECIAL EVENTS/FUND RAISERS?:
16b. IF YES, EXPLAIN:
17a. DOES YOUR GROUP TEACH CLASSES OPEN TO THE PUBLIC?:
17b. IF YES, EXPLAIN:
18. DO YOU HAVE USHERS TO ASSIST GUESTS?:
19a. DOES YOUR GROUP SERVE REFRESHMENTS?:
19b. FOR A CHARGE/DONATION?:
19c. ANNUAL REVENUE FROM REFRESHMENTS:
19d. DOES YOUR GROUP SERVE ALCOHOL?:
19e. ANNUAL LIQUOR REVENUE:
20a. NUMBER OF BOARD MEMBERS?:
20b. NUMBER OF FULL-TIME EMPLOYEES?:
20c. NUMBER OF PART-TIME EMPLOYEES?:
20d. DOES GROUP HAVE DIRECTOR/OFFICER LIABILITY INSURANCE?:
21. LIST NAME, ADDRESS, LOCATION OF ANY ADDITIONAL INSURED
(Landlord, Loss Payee, Mortgagee, etc.)
22. LIMIT NEEDED FOR THEATRICAL PROPERTIES?:
(Agreed Cost/Value To Replace All Theatre Properties - Sets, Lights, Props, Costumes, Etc.)
POLICY INCLUDES AN AUTOMATIC BLANKET PROPERTY LIMIT OF $100,000. THAT CAN BE APPLIED TO ANY OF 7 COVERAGE AREAS; PARTICULARLY TO COVER YOUR COMPUTERS.
23. BUSINESS PROPERTY (office equip/furniture other than computers) IS COVERED UP TO A LIMIT OF $1000.
INDICATE HIGHER LIMIT IF NEEDED.
24. THEFT OF BOX OFFICE RECEIPTS IS COVERED ($10,000 on premises/$5,000 off premises)
25. LOSS OF BUSINESS INCOME/EXTRA EXPENSE IS COVERED ($10,000).
26a. DO YOU OWN YOUR OWN BUILDING?:
26b. IF YES, PROVIDE COMPLETE ADDRESS:
27. IF YOU OWN YOUR OWN BUILDING, DO YOU RENT/LOAN IT TO OTHERS?:
28a. DO YOU LEASE/USE BUILDING OWNED BY SOMEONE ELSE?
28b. FROM WHOM?
WHETHER YOU OWN OR LEASE A PERFORMANCE SPACE, WE MUST KNOW WHICH OF THESE SAFETY FEATURES ARE PART OF THAT BUILDING. INDICATE "YES" OR "NO" FOR EACH:
29a. FIRE ALARM:
29b. FIRE EXTINGUISHERS
29c. FIRE HOSES:
29d. SMOKE DETECTORS:
29e. BURGLAR ALARM:
29f. SPRINKLER SYSTEM:
ANSWER FOLLOWING RE: YOUR PRINCIPAL PERFORMANCE SPACE
30a. NUMBER OF SEATS:
30b. NUMBER OF EXITS:
30c. DO ALL EXITS HAVE LIGHTED EXIT SIGNS?:
30d. DO ALL EXIT DOORS HAVE PANIC BAR HARDWARE?
30e. IS THERE EMERGENCY LIGHTING IN CASE OF POWER FAILURE?:
31. LIMIT OF INSURANCE NEEDED FOR OWNED BUILDING:
[32a - 32v] MUST BE ANSWERED ONLY IF YOU OWN A BUILDING
32a. YEAR BUILT:
32b. TYPE OF CONSTRUCTION:
32c. GROUND FLOOR SQ FOOTAGE:
32d. NUMBER OF STORIES:
32e. BASEMENT:
32f. IF YES, DESCRIBE:
32g. TYPE OF INTERIOR WALLS:
32h. TYPE OF FLOOR:
32i. TYPE OF ROOF:
32j. YEAR WIRING UPDATED:
32k. YEAR PLUMBING UPDATED:
32l. YEAR HEATING UPDATED:
32m. YEAR ROOF UPDATED:
32n. IS THERE COOKING ON PREMISES:
32o. IF YES, DESCRIBE:
32p. LIST/DESCRIBE OTHER BUILDING OCCUPANTS:
AS YOU FACE YOUR BUILDING, DESCRIBE WHAT IS ON THE
32q. LEFT
32r. DISTANCE FROM YOUR BUILDING:
32s. RIGHT
32t. DISTANCE FROM YOUR BUILDING
32u. REAR
32v. DISTANCE FROM YOUR BUILDING
33. DESCRIBE ANY INSURANCE LOSSES YOUR GROUP HAS HAD IN LAST 5 YEARS. BE SPECIFIC:
THIS INSURANCE IS AN EXCLUSIVE AACT MEMBER BENEFIT. TO PROVIDE FULL PRICING ADVANTAGES, WE MUST HAVE COMPLETE & ACCURATE INFORMATION, INCLUDING CURRENT PREMIUM. WITHOUT THIS WE CANNOT GUARANTEE THE FULL PRICE ADVANTAGE.
34a. CURRENT INSURANCE COMPANY:
34b. EXPIRATION DATE:
34c. CURRENT PREMIUM:
DATE
SIGNATURE
