PACKAGE CHOICE QUOTATION REQUEST

SSL Please complete and submit the following form with confidence: Hill & Usher does not sell or otherwise transfer any of its database information to other entities for the purposes of marketing to you.
Tell us about Yourself...
First Name
Nickname
(salutation for email messages)
Middle Initial
Last Name
Email Address
Email Address Confirm
Telephone Area Code & Number Ext
Mobile Phone Area Code & Number
Fax Area Code & Number
Business Website Address
Are you the final decision-maker
concerning insurance coverage
for your Company
Yes No
Mailing Address
Address Line 1
City
County
State
Zip Code
(+4 optional)
-
Physical Location of Your Business (if different than mailing address)
Address Line 1
City
County
State
Zip Code
(+4 optional)
-
Do you operate your photography business from any other physical location Yes No
Do you routinely store equipment or property at any other physical location Yes No
Tell us about your Business...
Complete Legal Name
of Primary Insured Individual or Entity
Registered Trade Name
(DBA, Studio Name, etc.)
Legal Structure

If Other Please Explain

Persons With Ownership Interest
List All Owners of the Business
(semicolon separated)
Business Operations & Experience
Years in Business
(under current business entity)
Photography or Videography Total Years Experience
Film Production Total Years Experience

Association Memberships

Advertising Photographers of America (APA)
American Society of Media Photographers (ASMP)
Editorial Photographers
National Association of Photoshop Professionals (NAPP)
National Press Photographers Association (NPPA)
Professional Photographers of America (PPA)
Wedding & Portrait Photographers (WPPI)
Other

Types of Photography or Videography Work Performed Advertising
Architectural
Aerial
Commercial
Industrial
Nature/Outdoor
Portraiture
Sports
Stock
Wedding or Event
Graphic Design
Website Design
-
Consulting
Educational Seminars
Photobooth
-
Other
Describe Other Photography or
Videography Work Performed

Motion Picture Production Work Performed
(if any)

Not Applicable
Documentary
Commercial
Industrial
Entertainment
Other

Property Valuation & Coverage Limits
Please provide the total amount (in whole US dollars) required to COMPLETELY REPLACE each type of property listed below (as if having suffered a total loss of that property today). These figures should represent what would be required to replace the property at current costs. Since some items increase (and others decrease) in price and/or value over time, these amounts may be significantly higher or lower than the original cost to purchase the item.

-- CONSIDER THESE VALUES CAREFULLY --
They will be the basis for the limits of coverage under your policy.
Please enter amounts in whole US dollars as numbers only, without punctuation.
EXAMPLE: 10000 (CORRECT) 10,000.00 (INCORRECT)
Cameras & Photographic Equipment
(do not include pc's, peripherals, software etc.)
$
Note: an accurate quotation requires an itemized listing of your photo equipment. For your convenience, we placed a link in the confirmation email you will receive after submitting of this form.
Maximum Value of Rented or Leased Photo Equipment in Your Custody at Any Given Time

Office/Studio Contents & Furnishings
(do not include pc's, peripherals, software etc.)

"Tenant Improvements and Betterments"
(coverage for permanent fixtures, cabinetry, appliances, or wall coverings installed in a rented/leased premises)

Photographic Portfolios

Computer Equipment
(hardware, software, & peripherals)

Your Studio Premises Residential Locations
Do you work from a residence Yes No
Total Area of Residence
(in square feet)
Area Used for Studio/Office
(in square feet)
Your Studio Premises Commercial Locations
Do you own a commercial building which houses your studio Yes No
If yes, what is the current replacement value of the structure
(if this is left blank, we will not provide any building coverage)
$
Total Area of Commercial Building
(in square feet)
Total Area of Your Studio/Business
(in square feet)
Your Studio Premises Commercial and Residential Locations
Type of Construction Used Erecting The Premises Structure

If you are unsure which of the following best describes the type of building construction, please consult the current insurance policy for a description of the type of construction. Construction documents, drawings, appraisals, or ownership documents may also help.

Frame Exterior walls of wood, brick veneer, stone veneer, wood ironclad, stucco on wood
Joisted Masonry Exterior walls of masonry material (adobe, brick, concrete, gypsum block, hollow concrete block, stone, title, or similar materials), with combustible floor and roof
Noncombustible Exterior walls, floor, and supports made of metal, asbestos, gypsum, or other noncombustible materials
Masonry Noncombustible Same as joisted masonry except that the floors and roof are of metal or other noncombustible materials
Modified Fire Resistive Exterior walls, floors and roof of masonry or fire-resistive material with a fire resistance rating of at least 1 hour, but less than 2 hours
Fire Resistive Exterior walls, floors and roof of masonry or fire-resistive materials with a fire-resistance rating of at least 2 hours
  Other, please explain
Year Building Constructed
If building is 25 years or older, how many years ago were the following updated
Wiring
Plumbing
Roofing
HVAC
Construction Quality
Do you lease parts of your building to other businesses Yes No
If yes, please describe all types of other businesses in your building or at the property address (Example: Greeting Card Store, Fast Food Restaurant)
Burglar Alarm System Yes No
Brand Name of Alarm
Air Conditioned Area
Basement Yes No
Number of Elevators (if any)
Fire Sprinkler System Yes No
Fire / Burglar Protections
(hold CTRL key to select multiple items)
Do you travel outside of US/Canada for business Yes No
Is your primary motor vehicle equipped with an alarm Yes No
Do you or any employees leave Photo equipment or other valuable property unattended in your motor vehicle Yes No
Value of Un-Attended Equipment $
Other Coverage-Related Information
Desired Liability Limits
(per occurrence)
$1000000
$2000000
Other
$
Annual Gross Sales $
Total Annual Payroll
{not including owner(s)}
$
Workers Compensation Insurance Provided for All Employees
(as required by law)
Yes No
Total Number of Staff Photographers
(employees)
Number of Other Employees
Total Number of Contracted Photographers
(non-employee/independent contractors)
Require Contractors to Carry Liability & Property Insurance Yes No
Require Independent Contractors to Carry Workers Compensation Yes No
Do employees/others drive personal vehicles on your behalf Yes No
Annual Estimated Number of Certificates of Insurance
Percentage of Total Business Derived From Website or Internet This Year
Additional Underwriting Information (Incomplete or inaccurate information will delay your quote or disqualify you for coverage.)
Current Policy Expiration Date (MM/DD/YYYY)
Current Insurance Carrier
Current Annual Premium $
Total Dollar Value of Claims (All Types) During the Last Five Years $
Number of Claims in Excess of $500 During Last Five Years
Please briefly describe each claim
(include dates & amounts paid)
Since the occurrence of claims, what changes in operations or safeguards have been instituted to protect from future loss
Additional Coverage Requests
Insurance Products · New window
Requested Policy Effective Date (MM/DD/YYYY)
(after your acceptance of our quotation and carrier approval of your application)
Optional (but greatly appreciated)...

How did you first come to learn about Package Choice

You may make multiple selections by holding down the control key on your keyboard while clicking on desired selections. To undo a selection(s), hold down the control key on your keyboard while clicking or double clicking on undesired selections.

If you came to us by way of a "Link From Another Site," what's the name of the site or what's its URL (website address)

If you found us via a search engine, what terms did you enter

Also add any comments/questions

Please attach any supporting document you wish us to review:

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IMPORTANT: Submit the Form...
By submitting this request, you attest to the accuracy and completeness of the information provided. You understand that no coverage is in force until a policy of insurance is approved and issued on your behalf. Hill & Usher will not be held responsible for coverages not available, coverages not requested by you, or limits not sufficient at the time of this submission.

No application will be submitted or bound with the insurance carrier until you have accepted our quotation.

IMPORTANT INFORMATION REGARDING THE USE OF YOUR INSURANCE/CREDIT SCORE:
By submitting this request for a quotation, you hereby permit the agency, its employees, owners, and affiliated insurers (HILL & USHER, LLC) to use data contained within your "insurance credit score" as the basis for determining your eligibility for our products where permitted by law.  You understand that an unacceptable "insurance credit score" as deemed by our insurance carrier(s) may result in your ineligibility for coverage.  You agree to hold HILL & USHER, LLC harmless from fault or liability in the event that your "insurance score" is unacceptable to the carrier(s), even if the information contained therein proves inaccurate in any way.
Due to privacy concerns and the proprietary nature of "insurance scores," HILL & USHER, LLC will not know the details of your "insurance score." In compliance with the Fair Credit Reporting Act http://www.ftc.gov/os/statutes/fcra.htm, you have the right to request information about your "insurance score" or to dispute in writing the results of an unfavorable "insurance score."  Upon request, HILL & USHER, LLC will furnish you with contact information for the relevant credit rating bureau.  Your "insurance credit score" is a combination of your business or personal credit history, loss history, and other factors that may reasonably predict the likelihood of future claims.

If you have Problems with this form, please email the webmaster or call our office at
(866) 977-4725 between 8AM and 5PM Monday through Friday, Arizona time.
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Restrictions on securing NEW policies, now in effect. 
Identity Theft Protection:
Available in Package Choice
Package Choice Membership Groups







Have Questions?
Need more information about Package Choice? Contact one of our licensed insurance professionals by phone or on our Contact Us form for assistance.

(866) 977-4725 


"When photographers and videographers think insurance, they think Hill & Usher. Contact us today to discover why Hill & Usher's Package Choice program is the unmatched leader in the market."
Richard B. Usher
Agency and Program Founder
Hill & Usher
© Hill & Usher, LLC. All Rights Reserved. CA #0C73815
Phone: (866) 977-4725 | Fax: (877) 956-4418