National Provider of Sports & Entertainment Insurance

 

PO BOX 948    Warrenville, IL    60555

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

info@dhcins.com

 

HOME PROGRAMS FAQ & LINKS CONTACT

Vendor Insurance Program Application

Premium Rates and Benefits - SINGLE VENDOR

Please check all plan numbers that apply.

$1,000,000.00 Per Occurrence / $1,000,000.00 Aggregate

 

Premium Rates and Benefits - GROUP VENDOR POLICIES

Please check all plan numbers that apply.

$1,000,000.00 Per Occurrence / $1,000,000.00 Aggregate

 

1. Program Rate Vendor 5 days or less:

$50.00 (Subject to $50 MP)

1. Program Rate Vendor 5 days or less:

$35.00 per vendor (Subject to $60 MP)

2. Program Rate Vendor 6-14 days:

$100.00 (Subject to $100 MP)

2. Program Rate Vendor 6-14 days:

$75.00 per vendor (Subject to $150 MP)

3. Program Rate Vendor 15-30 days;

$150.00 (Subject to $150 MP)

3. Program Rate Vendor 15-30 days:

$105.00 per vendor (Subject to $210 MP)

4. Program Rate Vendor 1-6 months:

$275.00 (Subject to $275 MP)

4. Program Rate Vendor 1-6 months: $205.00 per vendor (Subject to $410 MP)

5. Program Rate 6 months - Annual:

$350.00 (Subject to $350 MP)

5. Program Rate 6 months - Annual:

$260.00 per vendor (Subject to $520 MP)

6. Premium cost to increase the

    general aggregate to $2,000,000.00:

Additional 5% of total premium

6. Premium cost to increase the

    general aggregate to $2,000,000.00:

Additional 5% of total premium

7. Premium cost to increase the

    general aggregate to $3,000,000.00:

Additional 10% of total premium

7. Premium cost to increase the

    general aggregate to $3,000,000.00:

Additional 10% of total premium

8. Premium cost to increase the

    general aggregate to $4,000,000.00:

Additional 15% of total premium

8. Premium cost to increase the

    general aggregate to $4,000,000.00:

Additional 15% of total premium

9. Premium cost to increase the

    general aggregate to $5,000,000.00:

Additional 20% of total premium

9. Premium cost to increase the

    general aggregate to $5,000,000.00:

Additional 20% of total premium

 

   

 

Number of Vendors:  

 

 

 

 

 

 

 

MP = Minimum Premium is Fully Earned at Inception

DHC Insurance will calculate and confirm with Applicant the amount of the Group Premium.


Name of Applicant  

Email

   Fax 999-999-9999

Street Address  
City    State    Zip Code  
Phone    999-999-9999
Dates of Event  
Time(s)  
Location of event  
Description of Your Exhibit  

Has any prior coverage been cancelled or non-renewed?

 

If Yes, please describe and provide loss history

Name, Address and Relationship of all additional insured to be added to the policy:

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly provides false information on an application for insurance may be guilty of a crime, and may be subject to civil fines and criminal penalties.  I certify that the above information is true and coverage is not applicable until accepted by DHC Insurance, L.L.C.

Authorized Electronic Signature:                        

     

 

 

 


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PO BOX 948   |   Warrenville, IL   |   60555   |  (888) 288-1829 tel   (630) 393-5666 fax

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