National Association of Arms Shows, Inc.

Event Reporting Form 1-16-07/08

 Member:______________________________________________________________________________

Mailing Address________________________________________________________________________

#1

Name of Show__________________________________________________________________________

 Show dates from set up - breakdown____________________Estimated Paid Attendees________________

 Venue name:___________________________________________________________________________

Address_______________________________________________________________________________

Coverage provided is Liability Insurance on a claims made basis.

Limit $1,000,000 occurrence per event /$2,000,000 aggregate annually for the policy

$500 Deductible applies per claimant

This policy covers multiple insureds & multiple locations and is subject to one policy aggregate limit.

Pricing Per Event:

Attendance                                             Premium

1 – 2,500 people                                    $575.00

2,501 – 5,000 people                             $675.00

5,001 – 7,500 people                             $775.00

7,501 – 10,000 people                           $875.00

over 10,000+ is quoted on a case by case basis

NOTE: Please use your best estimate for paid attendees based on historical & budgeted data.

Shows you are ordering coverage for now:

1._______________________________premium____________

2._______________________________premium____________

3._______________________________premium____________

4._______________________________premium____________

5._______________________________premium____________

                                                                                ____________ Total combined premium

                                                                   ADD +____________  3.9% surplus lines tax to total premium

                                                                              $____________ Total to forward for insurance coverage

 Full payment is required when event is reported. You may send in check or pay by Mastercard or Visa

Credit card #__________________________________________________

exp date___________________

Coverage is available for NAAS members only.  As per your application to NAAS you have agreed to adhere to their code of ethics and follow the NAAS safety guidelines for all of your shows.  All guns must be secured with safety ties and no loaded guns are allowed in the building. Police/security officers must secure any firearms being brought into the building by consumers as well as exhibitors. Be diligent with safety and train your staff to be on the look out for slip and fall hazards as well as any other safety violations.                                           

Upon receipt of completed form and payment a certificate of insurance will be issued. Unless you instruct otherwise you will receive a certificate for yourself and the venue.    Please copy this form as needed. Questions call Allison or Belinda

Shoff Darby Co., 6527 Main St., Trumbull, CT 06611

T#800-840-7762 F#203-268-0687 website www.Shoffdarby.com/ShowsAndEvents