Select Policy Document Language: *
Insured Name or Business name (Whichever applies): *
Description of Products or Services offered at event: *
If you do not consent to Western using your information to contact you, we cannot help you with your insurance needs.
Is the kiosk located OUTSIDE of Canada?
*If yes, we will only offer Commercial General Liability Coverage ONLY, please provide additional details of event name and dates in comments section.: *
Are you operating an artist studio at your private residence as part of a studio tour?: *
Effective Date (common seasonal renewal February 15th):
Limit of Liability (million): *
Tenants legal liability limit:
Does your product or work involve any of the following:
(If yes, please enter details of your product or work in the below field called "Description of services" found in section 2 of this application): *
Will you have candles at your booth?: *
Are you doing E-Commerce (Online Sales) at your booth?: *
Will you be selling skin care products/cosmetics including, but not limited to: lotions and soaps?: *
Do you require loss or damage coverage to your own property in your own vendor space?:
Will you be setting up at two different locations on the same day?: *
Only ONE booth/kiosk/table or stand will be setup at any ONE given time. Additional set ups to be added by endorsement, subject to underwriting approval. Additional premiums may apply.: *
I hereby understand and agree that the following property is excluded: Jewels, jewellery, fine art, precious stones, antiques, furs, plants, shrubs, money and securities, automobiles, motorcycles and any other vehicles licensed for the road.: *
Will you be serving or selling food or beverages?: *
Will a deep fryer be used on site?: *
What type of fire suppression system will be used?:
Is this a Food truck and or trailer?: *
Will you be serving alcoholic beverages at your booth? (may incur additional premium):
If cooking/preparing food and/or beverages for onsite consumption has the health authority/department approved your food stand licensing? (If you are unsure of their requirements you will need to contact your Community Health Services Department to verify):
Do you require coverage extension to a commercial kitchen? (may incur additional premium):
Is this a private residence/home kitchen?:
Please provide the name and address of the Commercial Kitchen:
Were you hired/asked to serve food for an event? :
What is your annual gross receipts for the food you make and or sell?:
Do you require coverage if someone is injured by a product you make or sell (Not including Food or Beverage), or by work you have completed? (eg. Products and completed operations): *
Do you need to name any additional insureds with respect to any shows you will be exhibiting at?:
You can request future endorsements to add additional insured during the policy term. No Endorsement fee will be imposed for this type of request. However, any other type of endorsement request may be subject to an endorsement fee and / or additional premium.
Please describe the type of property:
Where will you store the property when not in use?:
Full address where the property is stored:
*Property must be stored at a location with locked doors or a working alarm or 24 hour security while not in use.
Is the premise sprinklered?:
Are there security personnel on site?:
Is there 24 hour security?:
Are there security cameras on site?:
Are there additional security measures while NOT in use:
Premium is FULLY EARNED, no return premium on cancellation. Please click yes to confirm that you agree: *
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 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.
