Camp Information

CAMP INFORMATION
Camp Name* Contact Person *
Legal Entity (if any)
Address*
City, State, ZIP*
Phone* Fax
Email * Website
Numbers of Years Attending Burning Man
General Liability
Arrival Date mm-dd-yy Departure Date mm-dd-yy
Description of theme camp:
Description of temporary structures:
How tall are your structures (approximately)?:
Can people climb to a second (or higher) level or floor?:
How many people are in your camp?:
Do you provide entertainment (DJ, fire dancers, pyrotechnic show)?:
Property Exposure (If Property Damage Coverage is Needed)
Equipment Value
How will you transport equipment to the playa (i.e., car, trailer, 3rd party shipper)?:
Do you have an art car(s)? If so, please complete the Art car questionnaire. Liability coverage for art cars is not included in both the theme camp and artist liability coverage.

Do you require a Loss Payee, Evidence of Insurance, or Additional Insured Certificate? If so, please provide the certificate holder's name and address. Please also include any special wording instructions.

877-731-7905