HAAS & WILKERSON INSURANCE
PO box 2946, Shawnee Mission, KS 66201-1346
PHONE 806-821-7703 FAX 913-676-9293 email: spinc@hwins.com
ENDORSEMENT REQUEST FORM
DATE:____________________
INSURED: _____ The Amarillo Tri-State Expo.________________By:___________________________
EVENT SPONSOR: The League of Celtic Nations__________________________________________
TYPE OF EVENT OR PRODUCT/SERVICE PROVIDED: Celtic Festival and Craft Faire________________
__________________________________________________________________________________
EVENT DATE(S): October 5 & 6, 2002__________ EST. ATTENDANCE:___________________________
LIQUOR LIABILITY REQUIRED_______________________
(MUST PHONE FOR ACCEPTABILITY AND/OR PREMIUM)
PREMIUM:_____ _______________ SERVICE CHARGE: ___________ TOTAL: ______________
*Service Fee does not apply to Vendors & Concessionaires during an event
ACE SPECIAL EVENT PRICING
CATEGORY: Meetings, Weddings, Picnics, Socials, Dinners,
Trade Shows, Small Animal Show & Clinic
TOTAL ATTENDANCE - PREMIUM
Under 200 - - $ 65
201 - 500 - - $ 90
501 - 1,500 - - $ 115
1,501 - 3,000 - - $ 165
3,001 - 5,000 - - $ 215
5,001 - 7,500 - - $ 265
7,501 - 10,000 - - $ 315
Over 10,000 - - Please Call
EVENTS PER DAY - - - PREMIUM
Flea Markets - - $ 105 each day
Horse/Cattle Shows - - $ 80 each day
Cattle/Horse Sales - - $ 105 each day
FAIR OR INTERIM EVENT CONCESSIONAIRE AND EXHIBITOR RATES:
TYPE - - - PREMIUM
First Booth (each exhibitor) - - $ 70
Each Add'l Booth (same exhibitor) - - $ 50
Each Game Booth - - $ 85
Please call for Dunking booths, Petting Zoos, Pony Rides, Golf Cart/Scooter Vendors, Parade Units
Items listed below require additional premium and should be approved before acceptance for endorsement to your policy:
Liquor Liability * Pony Rides * Petting Zoos * Exotic Animals * Game Booths/Arcades * Organ Grinders * Dunking Booths * Golf Carts/Scooters * Entertainers (Small Independent)
Items listed below are NOT acceptable for endorsement:
Permanent Tatoos, Body Piercing & Massages * Haunted Houses * Concerts/Promoters/Performers
Playground Equipment * Wheelchair/Stroller Rentals * Gun Shows * Climbing Walls * Ice/Roller Skating
Inflatable Amusements (includes Moonwalks, Bounces and Pillows) * Child Care * Rodeo Events
Amusement Rides/Devices (includes Gyroscopes and Spaceballs) * Motorsports Events
