Special Producers Motion Picture Production Package ...

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... Commercials Documentaries Educational films Training films Music videos Animated films Other(please describe) 14. Maximum cost any one production: $ 15. Maximum ...
700 N. Central Avenue, 8th Floor Glendale, CA 91203 Phone: 818.409.4087 Fax: 866.308.3217 [email protected] |385 Washington Street, SB04G Saint Paul, MN 55102 Phone: 651.310.2156 Fax: 651.310.8119 [email protected] |485 Lexington Avenue, Suite 400 New York, NY 10017 Phone: 917.778.6461 Fax: 917.778.7007 [email protected] | |Coverage provided by St. Paul Fire & Marine Insurance Company

Please complete this application, in addition to Acord 125, and send all attachments.

|Agent/Broker|      |Date of |      | |: | |Application: | | |Address: |      | |Contact: |      |Telephone Number: |      | |Email: |      |Fax Number: |      |

APPLICANT INFORMATION

|1. |Name of production company |      | | |(applicant): | | |2. |Address|      | | |: | | |3. |The applicant|An individual A partnership A corporation Other: | | |is: |      | | |If the applicant is a corporation, please provide the following names. | | |President |      |Vice president|      | | |Secretary |      |Treasurer |      | |4. |Experience of applicant (examples) | | |      | | |      | |5. |Years in this |      | | |business: | | |6. |a) Previous |      | | |insurer: | | | |b) Has the applicant ever had any special producers or similar | Yes No | | |insurance declined or canceled in the past five years? | | | |If yes, explain: |      | | |c) Describe any previous losses over $10,000 (insured or uninsured) sustained by | | |the producer in the past five (5) years: | | |      | | |      | |7. |Premium audit |      |Phone #:|      | | |contact: | | | | |8. |The Productions are| Film Tape Both |     %Film |     % Tape | | |on: | | | | |9. |Production | Union members | Non-union members | | |personnel are: | | | |10.|Estimated number of productions to be |      | | |produced annually: | | |11.|Estimated gross annual | | | |production costs: | | | |Tape |$      |Film |$      |Total |$      | |12.|Is any post-production work done for others? | Yes No | | |(Attach a copy of contract) | |Estimated annual |$      | | | | |receipts: | |

|13.|Types of films to be |Commercials |Documentaries | Educational films| | |produced: | | | | | | |Training films |Music videos | Animated films | | | | Other(please |      | | | |describe) | | |14.|Maximum cost any one |$      | | |production: | | |15.|Maximum loss exposure in dollars any one|$      | | |occurrence: | | | | |(Total amount of negative film without protection prints at any one time| | | |stored at one location.) | |16.|Maximum length of time any one production from start of photography |      | | |to date of protection print: | | | |(If over 90 days, please|      | | |explain) | | | | |      | |17.|Average estimated length of time from start of photography to date of protection | | |print of all productions to be insured: | | |      | |18.|Are projects scheduled or anticipated to be produced outside of the| Yes No | | |United States, the provinces of Canada, western Europe, Australia | | | |and New Zealand? | | | |If yes, |      | | |explain | | |19.|COVERAGES DESIRED | | |NEGATIVE FILM/ VIDEOTAPE | | |Name and location of | | | |principal: | | | |a) Laboratories to be used: |      | | |b) Vaults to be used: |      | | |c) Cutting rooms to be used: |      | | |d) Average distances of shooting locations|      | | |to laboratory: | | | |Any special film processes, special effects or equipment (e.g. | Yes No | | |Panavision, Cinerama, Imax, etc.)? | | | |Limit of |$      | | |coverage: | | | |FAULTY STOCK, CAMERA AND PROCESSING | | |Explain procedures the applicant follows in testing cameras, lenses, raw stock | | |and equipment to prove them to be sound prior to commencement of filming or | | |taping: | | |      | | |Number of days filmed material is accumulated prior to |      | | |processing | | | |Limit of |$      |Deductible|$      | | |coverage: | |: | | | |PROPS, SETS AND WARDROBE | | |Full 100% value of |$      |(attach schedule) | | |owned: | | | | |Rented: |$      |(maximum value at any one time) | | |Limit of coverage |$      |Deductible|$      | | |(owned): | |: | | | |Limit of coverage |$      |Deductible|$      | | |(rented): | |: | |

| |MISCELLANEOUS EQUIPMENT | | |Full 100% value of |$      |(attach schedule) | | |owned: | | | | |Rented: |$      |(maximum value at any one time) | | |Brief description of protection of property on the applicant’s premises; (fire | | |fighting equipment, watchman, alarm etc.): | | |      | | |Location to which miscellaneous equipment and props, sets and wardrobe will be | | |returned when not in use: | | |      | | |Limit of coverage |$      |Deductible|$      | | |(owned): | |: | | | |Limit of coverage |$      |Deductible|$      | | |(rented): | |: | | | |THIRD PARTY PROPERTY DAMAGE | | |Brief description of property (other than miscellaneous equipment, props, set, | | |etc.) or facilities to be used in connection with the production for which the | | |applicant may be responsible: | | |      | | |      | | |Limit of |$      |Deductible|$      | | |coverage: | |: | | | |EXTRA EXPENSE | | |(As a result of loss of or damage to property or facilities used in connection | | |with the insured production(s).) | | |Estimated time needed to reconstruct destroyed key |      | | |facilities, sets or scenery: | | | |Estimated time needed to replace lost or destroyed |      | | |equipment: | | | |What alternative location or studio facilities would be immediately available? | | |      | | |Limit of |$      |Deductible|$      | | |coverage: | |: | | | |BUSINESS PERSONAL PROPERTY | | |Full address of |      | | |premises/location(s): | | | |      | | |Full 100% value of |$      |(attach schedule) | | |owned: | | | | |Limit of coverage |$      |Deductible|$      | | |(owned): | |: | | | |Rented |$      |(maximum value at any one time) | | |Limit of coverage |$      |Deductible|$      | | |(rented): | |: | | | |NON OWNED AND HIRED AUTO PHYSICAL DAMAGE | | |Cost of hire: |Mobile studio units and film|$      | | | |trucks | | | | |Other than above |$      | | |Percentage of private passenger | Less than 50% of all vehicles | | |vehicle: | | | | | | Less than 25% of all vehicles |

| |OTHER COVERAGES (describe) | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      | | |      |

| |IMPORTANT | | |1. This policy does NOT cover the Insured for costs in excess of $25,000 for | | |talent, services or facilities provided by others and not budgeted and paid for | | |by the Insured, unless specifically declared and endorsed onto the policy. | | |2. The negative film and videotape coverage form contains an Important | | |representation in connection with artwork and drawings for animated productions; | | |a representation that the cameras, lenses and related equipment are to be fully | | |tested; as well as a coverage limitation as respects accumulated unprocessed | | |negative film in excess of five shooting days. |

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