Additional Insured form

To purchase liquor liability coverage, please provide the following information regarding your PTO event. If liquor is being served free-of-charge you do not require Liquor Liability Coverage (this is considered Host Liquor). If/when your event is approved we will be back in touch to collect any additional premium that may be necessary.

Section I: To add an additional insured, please answer the following.
*Any event with an estimated attendance over 800, will require underwriting review prior to issuing certificates.

First Name(*)

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Last name(*)

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Your Email(*)

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Your Phone Number(*)

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School Name(*)

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School Zip Code(*)

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Parent Group Name(*)

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Name of Additional Insured
(along with any special wording needed), if required

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Is an Additional Insured Endorsement required?

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Is your group sponsoring the event(*)

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Section II: Is this request for a specific event? If so, please complete the following questions:

Approximate Attendance

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Name of the Event

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Date of the Event

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Event Description

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Event Location

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Any risk-exposure extenuating circumstances
(i.e. parking lot safety)

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Section III: Does this event involve the sales or consumption of alcohol? If so, please complete the following questions:

What time will liquor be available (time range)

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Will food items also be available

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Estimated expected gross sales of liquor

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How is the liquor being sold? (Is there an open bar, cash bar, tickets exchanged or is it covered in the price of the event ticket, etc.)

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Indicate the number of drinks allowed per person

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Is the alcohol being purchased or donated by the parent group?

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Is a Vendor providing the liquor

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If yes, does the Vendor hold your state-required license/permit

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With whom is the vendor insured

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Has the vendor added you to its policy as Additional Insured

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Do you hold your state-required license/permit

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Please list provisions you will make for over-serving and dealing with possible inebriated drivers

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Careful consideration of event controls should be made for both Host Liquor and Liquor Liability events. Having food available is a good idea, and care should be taken regarding both serving intoxicated individuals and letting them drive.

Note: A liquor license or permit may be required for your event by your state! Coverage does not extend to BYOB events.

(*)

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