Exhibitors Insurance Application (Page 2 of 2) in pdf

NACORA INSURANCE BROKERS LTD

EXHIBITORS INSURANCE APPLICATION

.SAVE TIME/ORDER ON LINE:

Tel:

I - Exhibitor Company Name:

Fax:

Type of Business:

Unit/Ste

Province

Postal Code

Mailing address:

City

(*) Email address

(PLEASE FILL IN YOUR EMAIL ADDRESS):

II - Show Organizer

(Complete legal Name(s) to be added on certificate as additional insured ):

MediaEdge Communications Inc.

Address:

Unit/Ste

City

Province

Postal Code

5255 Yonge St.

1000

Toronto

Unit/Ste

Province

Event Name: Canadian Gaming Summit 2008

City

Booth#:

Address: Palais des congres

Montreal

Event Date (

)

Includes Move In and Move Out

Exhibitor Contact Name:

yyyy

FROM

2008

Apr

2008

May

2008

Signature____________________________________

III - PAYMENT TERMS AND CONDITIONS

TOTAL DUE =

$189.00

Preferred Rate

(For payment received at least 14 days before the opening day of show, Premium $72 + Fee $103.00 + PST $14.00)

Regular Rate

TOTAL DUE =

$203.00

(For payment received 13 days or less before the opening day of show, Premium $72 + Fee $115.96+ PST $15.04) 

A copy of the certificate will be made available to ( MediaEdge

) on your behalf and a copy for yourself if you include your email address.

Payment by:



Card#_________________________________

Expiry Date

(The payment due on the Credit Card statement will be in the name of )

Name of the Credit Card Holder: _________________________________________________________________

Important:

Fill in your credit card billing address if it is different from mailing address above, otherwise your payment cannot be processed.

___________________________________________________________________________________________________________

_______________________________________________________________________________________________________

 Cheque  Money Order (Please make Cheque or Money Order payable to Nacora Insurance Brokers Ltd.)

Date: ____/_____/_______

Signature ______________________________________________________

PLEASE REMIT PAYMENT TO:

Nacora Insurance Brokers Ltd

Programs Department,

, 80 Tiverton Court, Suite #801, Markham, ON L3R 0G4

Tel: 905-307-0307 ext. 222

Fax: 905 - 307 - 1234

Email:

Note: The above insurance program will only be offered if the application form is signed and completed in full, and the payment and the application form are received in

our offices prior to the opening show date. Note: Completion of this application does not automatically bind coverage; This application is subject to being approved prior to

binding. Premium and fee is minimum and retained. Coverage is void if payment is returned N.S.F. A full copy of this policy is available upon request or online at

SCHEDULE OF COVERAGES

$25,000 Property of Every Description (At the designated booth space) – Broad Form, Subject to $1,000 Deductible and a 90% Co-Insurance.

Note: Property excluded from coverage – EDP (Electronic Data Processing), audio & video equipment, watches, jewellery made of precious or semi precious stones

and/or precious metals, money, bullion, securities, stamps, antiques, furs, and fine arts valued at $5,000 per item or greater.

$2,000,000 Comprehensive General Liability – Bodily injury and Property Damage Liability, Subject to $1,000 BI & PD Ded – Inclusive each occurrence –Products and

Completed Operations Liability $2,000,000 annual aggregate, Employees as additional insureds, Contingent Employers Liability, Broad Form Property Damage, , Cross

Liability Clause, Severability of Interest Clause.

$100,000 Tenants Legal Liability – Broad Form

- Coverage is subject to: Asbestos Exclusion, Mold Fungi Exclusion, Data, War, Nuclear, Property flood and earthquake exclusion. Territory Restriction – Canada.

This schedule of coverage, provides all coverages for the exhibitors’ own property up to $25,000 while at the show as well as 3 days transit to and from the event.

- Ineligible Risks: Chemicals, Fertilizers, Pharmaceuticals, Nutraceuticals, Vitamins, Health or Dietary Supplements, Firearms, Pesticides, Fireworks, Computers,

Alcoholic beverages, Games, Licensed or Unlicensed Motorized Vehicles- including but not limited to: Motorcycles, Watercrafts, All terrain Vehicles, and Tractors. Note:

There is no Liability coverage for Vehicles in Motion.

- Insurer: Certain Lloyds Underwriters through Nacora Insurance Brokers Ltd.

By completing this application and returning it to Nacora Insurance Brokers Ltd, you agree and consent to the collection, use and disclosure of such information, including any personal

information, by Nacora Insurance Brokers Ltd for the following purposes:

- Communicating with You

- Negotiating, maintaining or renewing insurance

- Advising you of other products or services.

- Accessing your application for insurance.

on your behalf.

- Complying with regulators and legal

- Disclosing information to Insurance Companies.

- Providing claims assistance and service.

authorities.

For more information about our privacy policies and practices or for a copy of our Privacy Policy please visit our web site

or Contact: