Musicians’ Instrument, Equipment & Liability Insurance
HUB International Who we are…
Program Features
HUB International is an organization that is structured around large regional “hubs” with satellite offices strategically located throughout the United States and Canada. Locally, HUB offers personal service, individual attention and has the ability to respond quickly to your changing needs. Collectively, the hubs are a knowledge powerhouse providing you with tailor-made solutions that are designed by drawing upon our combined skills and expertise. With more than 200 offices, we are licensed to conduct business in every state and province in North America.
Sandra Sween, Account Manager
3063 Walker Road Windsor, ON N8W 3R4
Service 519.972.7500 x 253 sandra.sween@hubinternational.com Toll Free 800.563.9441 www.hubinternational.com Fax 519.966.6177
Worldwide coverage
Rental reimbursement if you need to rent an instrument or equipment in the event of a loss, up to $1,000
$50 deductible
Commercial General Liability including bodily injury, property damage, medical payments, tenants legal liability and non-owned automobile
Promotional Material Limit of $2,500 included with policy
$2.75 rate per $100 sum insured for Instruments and Equipment
Liability rates ($500 deductible): $1,000,000 limit - $25 per member $2,000,000 limit - $50 per member (higher limits available upon request)
Please complete the form on the reverse. Mail with your cheque made payable to:
HARMONY… Insurance, In-tune with your needs. Insurance • Financial Services
Application for Coverage
We balance the strength of an international firm with the accessibility of a local broker.
HUB International Ontario Limited
All risks coverage on your instruments and equipment
Rates and Premiums
HUB International Ontario Limited, 3063 Walker Road, Windsor, ON N8W 3R4 Telephone: 519.966.2600 Fax: 519.966.6177 Email: sandra.sween@hubinternational.com Website: www.hkmb.com/AEmusicianinsurance
Toll Free: 800.563.9441
Need more information? This brochure contains only highlights of the coverages provided. If you would like more information, please contact the Music Department at HUB International Ontario Limited. We would be pleased to answer your questions and personally assist you in putting together an insurance package.
Application for Musicians’ Instrument, Equipment & Liability Coverage Full Name of Insured:
Telephone Number:
AFM/CFM Local No: (if applicable)
Mailing Address (including Postal Code):
Artist ID/Member Number:
Street Member’s E-mail Address a/o Website Address:
Town, Province
Postal Code
If you are a member of a group, provide the name of the group:
Number in Group:
Previous Insurer:
Expiry Date:
Policy Number:
Previous insurance declined or cancelled? (If yes, Please provide full details):
Any claims in the last 5 years?
□ Yes □ No
(If yes, provide full details, including date, type of loss, amount paid and outstanding):
Insurance Coverage Requirements List each instrument or piece separately. Description of Item
Quantity Set
Attached separate sheet, if necessary Total Replacement Cost
Make, Model & Serial Number
Total Replacement Cost of all Instruments & Equipment Multiply by $2.75 for every $100 of value
X $2.75
Total Instrument / Equipment Premium Liability Limit $1,000,000 = $25 multiplied by No. of members
X $25
Liability Limit $2,000,000 = $50 multiplied by No. of members
X $50
Total Policy Premium: Applicable Taxes: Total Policy Premium (Please make cheque payable to HUB International Ontario Limited or provide credit card number & expiry date below)
Visa Number
Expiry Date:
Mastercard Number:
I may have provided personal information in this document and by other means and I may in the future provide further personal information. Some of this personal information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose any of this personal information, subject to the law and to my broker’s or insurance company’s policy regarding personal information and underwriting my policies, renewals, changes of coverage, evaluating claims, detecting and preventing fraud and analyzing business results. I confirm that all individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf. Signature: Date:
HUB International Ontario Limited
Revised: June 2009