Event Insurance For Fireworks Display – Enquiry Form

If this isn’t quite the insurance cover you were looking for, please complete our standard enquiry form.

Please leave this field empty.

Contact Name (required)

Name of Insured (required)

Is the Insured a: (required)

Your Address and Postcode (required)

Email Address (required)

Contact Number (required)

You are an: (required)

Have you ever suffered a loss (whether insured or not) in respect of any similar events
YesNo

If 'Yes' please provide details

Event Name (required)

Name of Venue (required)

Location Venue Address (required)

Location Venue Postcode(required)

Start Date of Event (required)

Finish Date of Event (required)

Period at venue (including set up and breakdown)

Have all the licences, visas, permits been obtained and are all contractual arrangements in writing for the event?
YesNo

If 'No' please provide details

Public Liability Cover (required)
Not required£1 million£2 million£5 million£10 million£15 million£20 million£20 million +

Maximum Attendance Throughout Entire Duration of Event (required)

Have you undertaken a risk assessment of the fireworks event? You may be asked to produce this
YesNo

Do you have a written health and safety policy that all contractors/exhibitors are made aware of and required to comply with?
YesNo

Who is responsible for the firing of the fireworks?

If the answer is "Third Party Supplier" please complete questions A, B, C & D.

A) If the answer to the question above is "Third Party Supplier" will you check to ensure that such independent suppliers have their own Public Liability insurance with a Limit of Indemnity at least equal to that which you have requested and check that their insurance will be current for the entirety of your event? If the answer is No you must inform us immediately.
YesNo

B) Name of Fireworks Company

C) Do they have their own Public Liability Insurance?
YesNo

D) What limit of Indemnity? £

Will there be a bonfire at the event?
YesNo

Who is responsible for erecting & clearing up the bonfire before and after the event?

Is property cover required? (required)
YesNo

Property cover sum to be insured £

Employers Liability Cover (required)
YesNot required

Number of paid employees and unpaid volunteers & assistants (required)

Company ERN Number (if applicable)

Do any employees/volunteers carry out work at height in excess of 5m or depth of 2m?

YesNo

Do any employees/volunteers carry out work involving the application of heat, other than the preparation of food and drink?
YesNo

Are you aware of any matter, fact, circumstance or incident existing or threatened that could possibly affect the Event(s) to be insured which might result in a loss under this insurance?
YesNo

If Yes please supply full details.

Is cancellation cover required?
YesNo

Cancellation cover sum to be insured £

Do you confirm that no official, committee member, you or co-organiser:
- Has sustained any loss for damage or liability during the last 3 years, whether insured or not
- Has had any insurance declined, cancelled, refused or had special terms imposed
- Has been convicted of or charged (but not yet tried) or been given an official police caution in respect of any criminal offence other than a motoring offence
- Has been declared bankrupt, insolvent or gone into liquidation
- Has been the subject of a County Court Judgement, an Individual Voluntary Arrangement, a Company Voluntary Arrangement or a Sheriff Court Decree
- Has been disqualified from being a company director
- Has been prosecuted or have prosecutions pending under the Health & Safety at Work Act or any other statute or regulation
- Has been censured by any Regulatory or trade body or any action taken against the company by the office of fair trading, consumer groups or the alike
YesNo

If 'No' please provide details

Notes and additional information

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