National Provider of Sports & Entertainment Insurance


13100 Shire Lane    Fort Myers, FL    33912

 (888) 288-1829 tel (630) 393-5666 fax



Quotation Request

 * = required field

Name of Policyholder*  


   Fax 999-999-9999

Street Address*  
City*    State*     Zip Code* 
Phone*    999-999-9999
Nature of Business/Activity.*  

Total Number of Participants*

(see note below)

  (for the entire duration of coverage)
Number of Staff / Coaches*   
How long do you require Coverage*  

Sport / Activity*


Age Range of Participants*




Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits application of files claims containing false or deceptive statement may be guilty of insurance fraud.

Authorized Electronic Signature*:
Title or Position:

NOTE:  Quotes are based on Participant Numbers.  In order to quote correctly, we need to know exactly how many participants you will have for the entire duration of the policy.  It is not based on how many you will have at one time.





DHC is a USA company and can not provide coverage outside of the USA.

Copyright © 2010-2017.  DHC Insurance, LLC.  All Rights Reserved.

13100 Shire Lane   |   Fort Myers, FL   |   33912   |  (888) 288-1829 tel   (630) 393-5666 fax

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