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Section 1

Reference #
24-169491


Select Policy Document Language: * 
 
Province: * 
 
Search by Event Location or Name of Venue: * 
   
Name of location of event: * 
   
Address of location: * 
   
City: * 
   
Location Type: * 
 
Postal Code: * 
   
Limit of liability required: * 
 
Is this a private residence, house, farm or field?: * 
               

Section 2

Name of insured: * 
   
If individual, date of birth: 
 
Address: * 
   
City: * 
   
Province: * 
 
Postal Code: * 
   
Phone Number: * 
   
Email: 
   
Additional Insured: * 
               

Section 3

Add Additional Insured: If an additional insured is required to be named, please describe the additional insured relationship to the event. Select if the additional insured is the Event Venue or Event City/Municipality and provide their name and address. Then select the ADD ADDITIONAL INSURED. You may add more additional insureds by repeating these steps.
Type: * 
 
 
 
Name Of Additional Insured: * 
   
Address:    
   
City:    
   
Province:    
 
Postal Code:    
   


Section 4

Is this an event with sports or athletic activities?: * 
               
Is this a sport tournament?: 
 
Can you confirm first aid supplies/ first aid services are readily available on site?: 
               
Is this a professional sport/athletic event?: 
               
Is coverage required for injury to participants in sporting events arising out of the negligence of the event host / organizer?: 
               
Is the applicant participating in, managing, or organizing any of the following: sports club and/or league, sporting association, or sporting tournament?: 
               
Are Waivers signed by all participants?: 
               
Is the event a virtual event?: 
               
If yes, does the VIRTUAL portion of your event involve sporting/athletic activities or alcohol service/consumption.: 
               
Will there be alcohol service/consumption at any of the activities excluding Virtual portion?: 
               
Event Type: * 
 
Additional Event Details, If Applicable: 
   
Event Effective Date: * 
 
Start Time: * 
 
Event Expiry Date: * 
 
End Time: * 
 
Max # of attendees (per day): * 
   
Max # of attendees (whole event): * 
   
Admission Fee ($): * 
   

Section 5

Will there be entertainment at the event?: * 
 
 
 
 
 
Is this event being held at a night club or rave style event?: 
               
Entertainment Performer: 
   
Entertainment Type: 
               
Entertainment Genre: 
   
Is coverage required for injury, arising from your negligence, to the performers/entertainers at your event?: 
               
Will there be vendors or exhibitors at the event: * 
               
Is proof of insurance a requirement for the vendors/exhibitors to set-up at the event: 
               
Will food and beverages be served at the event: * 
               
Who is providing food and / or beverages?: 
 

Section 6

**CANNABIS EVENT LIABILITY**


ATTENTION: Event Attendees may bring their own legally sourced Cannabis to this event! AND, you as an event organizer MAY NOT BE AWARE of this heightened exposure.

There will be an automatic “Cannabis Event Liability” Extension option that will pre-populate with your quotation if you would like to purchase this Cannabis Coverage extension AS AN ADD ON.

Please complete below for all other Cannabis Exposure.

Will there be cannabis consumed at the event / on the event premises?: * 
               
Will any cannabis (or variety of cannabis) be supplied by the applicant/host of the event?: 
               
All Cannabis smoking/vaping MUST take place outdoors check YES to confirm: 
               
Have all permits and licenses etc been approved and granted from the government or municipality or regulators?: 
               
Will any cannabis (or variety of cannabis) be supplied by a third party vendor?: 
 
 
 
Will the third party vendor carry their own cannabis liability at a minimum of $2 million dollars?: 
               
Will there be a legally licensed Cannabis designated area outdoors?: 
               
How many people in the designated area?: 
   
Will ID checks be in place for cannabis area?: 
               
Will there be security personnel in place with their own insurance coverage for their operations?: 
               

Section 7

Will there be alcohol served/consumed at any of the activities: * 
               
How many days of alcohol coverage do you require?: 
 

Section 8

Who is in charge of the service of alcohol: 
 


All Rules and Regulations pertaining to the service and/or consumption of alcohol must be abided.

Date: 
 
From: 
 
To: 
 
Location: 
   
# of patrons: 
   
Are servers trained: 
               
Date: 
 
From: 
 
To: 
 
Location: 
   
# of patrons: 
   
Are servers trained: 
               
Date: 
 
From: 
 
To: 
 
Location: 
   
# of patrons: 
   
Date: 
 
From: 
 
To: 
 
Location: 
   
# of patrons: 
   

If alcohol is served/ consumed at additional activities, please insert information in comment box below.

Additional details/ activities: 
   

Section 9

Will fireworks/ special effects or petting zoos/ other animals be involved in the event. If yes, a certificate of insurance or further underwriting may be required.: * 
 
Will there be any inflatables/ jumping castle: * 
               
Details: 
 
If yes, is coverage secured elsewhere?: 
               
If no coverage is in place elsewhere, an extension with a sublimit of $250,000.00 is available to be added to the policy, subject to additional premium of $50.00.
Do you want coverage? (some restrictions may apply): 
               
Will there be a parade: * 
               
If yes, please specify the number of units in the parade: 
   
Length of Parade: 
   
Police Escort: 
               
Are there any horses: 
               
If YES to horses, please confirm if each horse owner is required to provide proof of insurance prior to the parade.: 
               
Is the applicant providing any overnight camping or other accommodation: * 
               
Accommodation type: 
 
Other - please specify: 
   
If event involves youth, please provide sleeping arrangement details: 
   

Section 10

Will any temporary grandstands, bleachers or stages be set-up: * 
               
If yes, who will do the installation: 
   
Will a certificate of insurance be provided by the installer(s): 
               
Please provide details on the installation: 
   
Who will be providing security at the event: * 
 
How many people on site for security/ supervision: 
   
Will there be any designated children areas (ie: babysitting): * 
               
If yes, please provide pick-up / identification procedures: 
   
Has the event been held in the past: * 
               

Section 11

Previous Insurer and premium paid: 
   
Have you had any claims / loss history?: * 
               
If so, please provide details: 
   
Do you have any special request for coverage: 
   
Have you been declined or cancelled by any other insurer(s).: * 
               
Loss History: 
   
Do you require property coverage for items you own or rent?: 
 
Property covered, other amount: 
   
Please describe the property to be covered?: 
   
General comments: 
   
You may wish to attach any photos, posters, brochures, diagrams, or any additional information that would be may be useful for underwriting purposes.
Attachment: 
   
Attachment #2: 
   

Section 12

Brokerage Name: * 
   
First Name: * 
   
Last Name: * 
   
Address: * 
   
City: * 
   
Province: * 
 
Postal Code: * 
   
Email: * 
   
Verify Email: * 
   
Phone: * 
   
I /We hereby declare that the answers and declarations above, whether in my own hand or not, are true and that I /we warrant that no material fact has been withheld or misstated and agree that this proposal will form part of the policy and will form the basis of the contract with underwriters. I /we understand that the underwriters may declare any policy issued void in the event of any false statement, misrepresentation, omission or concealment whether made intentionally, innocently or accidentally. For purposes of the Insurance Companies Act (Canada), this document was issued in the course of Lloyd's Underwriters' insurance business in Canada
I/we agree: * 
        
I have reviewed the information above and have ensured it is 100% accurate. I have also included any Additional Insureds that may be required within the Venue’s rental agreement/requirements.
Check to confirm: * 
        


Please note that this is an application only. It does not constitute an insurance policy. Insurance shall become effective only on issuance of a policy or written binder specifically authorized by the company or agency. Quotations will be based upon the information provided and applicant warrants information provided.

   

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CUSTOMER SERVICE
E-mail:  ontario@palcanada.com
Phone: 1-800-265-8098 ext. 828
Hours: Ontario 8:30am to 4:30pm EST Alberta 8:30am to 4:30pm MST

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section arrow

Section 1

Reference #
24-169491


Select Policy Document Language: * 
 
Province: * 
 
Search by Event Location or Name of Venue: * 
   
Name of location of event: * 
   
Address of location: * 
   
City: * 
   
Location Type: * 
 
Postal Code: * 
   
Limit of liability required: * 
 
Is this a private residence, house, farm or field?: * 
               

Section 2

Name of insured: * 
   
If individual, date of birth: 
 
Address: * 
   
City: * 
   
Province: * 
 
Postal Code: * 
   
Phone Number: * 
   
Email: 
   
Additional Insured: * 
               

Section 3

Add Additional Insured: If an additional insured is required to be named, please describe the additional insured relationship to the event. Select if the additional insured is the Event Venue or Event City/Municipality and provide their name and address. Then select the ADD ADDITIONAL INSURED. You may add more additional insureds by repeating these steps.
Type: * 
 
 
 
Name Of Additional Insured: * 
   
Address:    
   
City:    
   
Province:    
 
Postal Code:    
   


Section 4

Is this an event with sports or athletic activities?: * 
               
Is this a sport tournament?: 
 
Can you confirm first aid supplies/ first aid services are readily available on site?: 
               
Is this a professional sport/athletic event?: 
               
Is coverage required for injury to participants in sporting events arising out of the negligence of the event host / organizer?: 
               
Is the applicant participating in, managing, or organizing any of the following: sports club and/or league, sporting association, or sporting tournament?: 
               
Are Waivers signed by all participants?: 
               
Is the event a virtual event?: 
               
If yes, does the VIRTUAL portion of your event involve sporting/athletic activities or alcohol service/consumption.: 
               
Will there be alcohol service/consumption at any of the activities excluding Virtual portion?: 
               
Event Type: * 
 
Additional Event Details, If Applicable: 
   
Event Effective Date: * 
 
Start Time: * 
 
Event Expiry Date: * 
 
End Time: * 
 
Max # of attendees (per day): * 
   
Max # of attendees (whole event): * 
   
Admission Fee ($): * 
   

Section 5

Will there be entertainment at the event?: * 
 
 
 
 
 
Is this event being held at a night club or rave style event?: 
               
Entertainment Performer: 
   
Entertainment Type: 
               
Entertainment Genre: 
   
Is coverage required for injury, arising from your negligence, to the performers/entertainers at your event?: 
               
Will there be vendors or exhibitors at the event: * 
               
Is proof of insurance a requirement for the vendors/exhibitors to set-up at the event: 
               
Will food and beverages be served at the event: * 
               
Who is providing food and / or beverages?: 
 

Section 6

**CANNABIS EVENT LIABILITY**


ATTENTION: Event Attendees may bring their own legally sourced Cannabis to this event! AND, you as an event organizer MAY NOT BE AWARE of this heightened exposure.

There will be an automatic “Cannabis Event Liability” Extension option that will pre-populate with your quotation if you would like to purchase this Cannabis Coverage extension AS AN ADD ON.

Please complete below for all other Cannabis Exposure.

Will there be cannabis consumed at the event / on the event premises?: * 
               
Will any cannabis (or variety of cannabis) be supplied by the applicant/host of the event?: 
               
All Cannabis smoking/vaping MUST take place outdoors check YES to confirm: 
               
Have all permits and licenses etc been approved and granted from the government or municipality or regulators?: 
               
Will any cannabis (or variety of cannabis) be supplied by a third party vendor?: 
 
 
 
Will the third party vendor carry their own cannabis liability at a minimum of $2 million dollars?: 
               
Will there be a legally licensed Cannabis designated area outdoors?: 
               
How many people in the designated area?: 
   
Will ID checks be in place for cannabis area?: 
               
Will there be security personnel in place with their own insurance coverage for their operations?: 
               

Section 7

Will there be alcohol served/consumed at any of the activities: * 
               
How many days of alcohol coverage do you require?: 
 

Section 8

Who is in charge of the service of alcohol: 
 


All Rules and Regulations pertaining to the service and/or consumption of alcohol must be abided.

Date: 
 
From: 
 
To: 
 
Location: 
   
# of patrons: 
   
Are servers trained: 
               
Date: 
 
From: 
 
To: 
 
Location: 
   
# of patrons: 
   
Are servers trained: 
               
Date: 
 
From: 
 
To: 
 
Location: 
   
# of patrons: 
   
Date: 
 
From: 
 
To: 
 
Location: 
   
# of patrons: 
   

If alcohol is served/ consumed at additional activities, please insert information in comment box below.

Additional details/ activities: 
   

Section 9

Will fireworks/ special effects or petting zoos/ other animals be involved in the event. If yes, a certificate of insurance or further underwriting may be required.: * 
 
Will there be any inflatables/ jumping castle: * 
               
Details: 
 
If yes, is coverage secured elsewhere?: 
               
If no coverage is in place elsewhere, an extension with a sublimit of $250,000.00 is available to be added to the policy, subject to additional premium of $50.00.
Do you want coverage? (some restrictions may apply): 
               
Will there be a parade: * 
               
If yes, please specify the number of units in the parade: 
   
Length of Parade: 
   
Police Escort: 
               
Are there any horses: 
               
If YES to horses, please confirm if each horse owner is required to provide proof of insurance prior to the parade.: 
               
Is the applicant providing any overnight camping or other accommodation: * 
               
Accommodation type: 
 
Other - please specify: 
   
If event involves youth, please provide sleeping arrangement details: 
   

Section 10

Will any temporary grandstands, bleachers or stages be set-up: * 
               
If yes, who will do the installation: 
   
Will a certificate of insurance be provided by the installer(s): 
               
Please provide details on the installation: 
   
Who will be providing security at the event: * 
 
How many people on site for security/ supervision: 
   
Will there be any designated children areas (ie: babysitting): * 
               
If yes, please provide pick-up / identification procedures: 
   
Has the event been held in the past: * 
               

Section 11

Previous Insurer and premium paid: 
   
Have you had any claims / loss history?: * 
               
If so, please provide details: 
   
Do you have any special request for coverage: 
   
Have you been declined or cancelled by any other insurer(s).: * 
               
Loss History: 
   
Do you require property coverage for items you own or rent?: 
 
Property covered, other amount: 
   
Please describe the property to be covered?: 
   
General comments: 
   
You may wish to attach any photos, posters, brochures, diagrams, or any additional information that would be may be useful for underwriting purposes.
Attachment: 
   
Attachment #2: 
   

Section 12

Brokerage Name: * 
   
First Name: * 
   
Last Name: * 
   
Address: * 
   
City: * 
   
Province: * 
 
Postal Code: * 
   
Email: * 
   
Verify Email: * 
   
Phone: * 
   
I /We hereby declare that the answers and declarations above, whether in my own hand or not, are true and that I /we warrant that no material fact has been withheld or misstated and agree that this proposal will form part of the policy and will form the basis of the contract with underwriters. I /we understand that the underwriters may declare any policy issued void in the event of any false statement, misrepresentation, omission or concealment whether made intentionally, innocently or accidentally. For purposes of the Insurance Companies Act (Canada), this document was issued in the course of Lloyd's Underwriters' insurance business in Canada
I/we agree: * 
        
I have reviewed the information above and have ensured it is 100% accurate. I have also included any Additional Insureds that may be required within the Venue’s rental agreement/requirements.
Check to confirm: * 
        


Please note that this is an application only. It does not constitute an insurance policy. Insurance shall become effective only on issuance of a policy or written binder specifically authorized by the company or agency. Quotations will be based upon the information provided and applicant warrants information provided.

   
   

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