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Applicant Information
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Event Information
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Bayou Haven Event Liability Insurance Form
Completion of this enrollment form confirms your desire to obtain insurance through the Sports, Leisure and Entertainment Risk Purchasing Group. The submission of this enrollment form and/or acceptance of payment does not guarantee coverage. Certain operations are not eligible for coverage by this program. WORLD EVENTS INSURANCE reserves the right to decline any request for coverage.
*POLICIES WILL BE PROCESSED WITHIN 1-2 BUSINESS DAYS.
NOTE:
Disregard Paypal only option at checkout. Continue with checkout and credit/debit option will be available.
Name of Applicant
Applicant Address
Phone
Email
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Bayou Haven Event Liability Insurance Form
Event Name
Type of Event
Aniversary Party
Baptism/Christening/Communion/Confirmation
Bar/Bat Mitzvah
Birthday Party
Business/Non-Profit (Banquet/Dinner/Luncheon/Meeting)
Business/Non-Profit Party (Holiday/Private)
Engagement Party
Family Party
Shower(Bridal/Baby/Wedding)
Social Gathering
Retirement Party
Non-Profit Private Fundraiser
Wedding/Wedding Reception
Aniversary Party
Indoor / Outdoor
Indoor
Indoor/Outdoor
Outdoor
Indoor
Event Start Date
MM
/
DD
/
YYYY
Event End Date
MM
/
DD
/
YYYY
If event goes past 12 midnight, then add next day to coverage.
Choose Your # of Guests
1-100 Guests
101-200 Guests
201-350 Guests
351-500 Guests
501-750 Guests
Have you had more than $5,000 of total claims in the last three years?
Yes
No
Alcoholic beverages are (select one):
Not available at the event
Furnished without charge and/or BYOB
Not available at the event
Are individuals charged to attend the event?
Yes
No
Alcohol is served by
Event host, employees or volunteers
Licensed caterer or the venue
Are there designated servers for the alcoholic beverages who have been instructed to not serve liquor to minors or intoxicated guests?
Yes
No
Venue:
Bayou Haven Wedding and Events, LLC
6021 Twin Bridges Road, Alexandria, LA. 71303
info@bayouhaven.com
Is Additional Insured Certificate Needed?
Yes
No
Relationship of Additional Insured
Venue
Owner/Lessor of Premises
Co-Promoter/Sponsor
Government Entity
Venue
Is an Endorsement needed?
Yes
No
Special Certificate Language Needed?
Bayou Haven Wedding and Events, LLC is added as an additional insured.
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Applicant Information
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Event Information
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Quote
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Bayou Haven Event Liability Insurance Form
Any questions, contact us at (800) 389-3900
THIS POLICY HAS NO DEDUCTIBLE!
NOTE: PAYPAL ACCOUNT IS NOT REQUIRED TO PURCHASE. ALL CREDIT CARDS ACCEPTED!
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