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Prop House Rental
Students: Read and Complete This Entire Form
GENERAL INSTRUCTIONS:
Use the TAB key or MOUSE click to move from field to field.
CAUTION: Using the ENTER key will automatically submit the form.

PLEASE REVIEW YOUR SUBMISSION BEFORE CLICKING "SUBMIT"
Distribution of Certificates
Standard Certificate of Insurance requests will be processed and distributed within 5 BUSINESS DAYS of receipt of your submission, as long as the information provided is complete and accurate.

Note: If you checked off any SPECIAL INSURANCE REQUEST, it may take an additional one to two weeks to process your insurance, so start early.
PLAN ACCORDINGLY!!

Note 1: Policy deductible is $2,500 Each Loss, and Limit can't exceed $100,000.00
for all Prop Equipment in your possession at any one time.
Please also note that there is a $25,000.00 sublimit for the use of Antiques and Jewelry.

GENERAL PRODUCTION INFORMATION

Have you submitted the "Production Registration Form"?:
Yes  No

If you answered "No" this will redirect you to the proper Production Registration Form.

Original Name of Production:

Director's Name (No nicknames. List name as registered with NYU!):
First Name:
Last Name:
Insurance Contact - Email Address:
Email address must be an NYU issued email.
Must end in @nyu.edu. All others will be rejected, and your form will have to be resubmitted.

CSI STUDENT PROPERTY INSURANCE

Are You Enrolled in the Student Property Insurance Program?: Yes No

Policy Number:
Policy Start Date: Policy Expiration Date:
Purchased Camera Endorsement?: Yes No

PROP HOUSE INFORMATION

SUBMIT ONLY ONE PROP HOUSE PER FORM!

Name and Address of PROP HOUSE:
(Name & Complete Address, including Zip Code):
Name:
Address:
City: State: Zip Code:


Schedule of Props with Replacement Values (Not Rental Costs):
Example:
Furniture - $3,300
Costumes - $5,000


Total Replacement Value of Props listed above
($100,000.00 Maximum limit): $

(For higher limits, or other insurance not listed above,
go to the Special Insurance section and select the appropriate button!)

SPECIAL ADDITIONAL INSURED WORDING

If the Prop House is requesting specific wording
(i.e. Additional Names, Entities listed as "additional insured")
Please provide the requested wording here:

SPECIAL INSURANCE & POTENTIALLY HAZARDOUS EXPOSURES

Note: If you have already submitted details for a "Special Insurance Request", please do not check the "Special Insurance" box again, unless you are requesting approval for a new scene or activity for this Production.


SPECIAL INSURANCE REQUESTS
The Student Project contains one or more of the following
(Check all that apply):

Simulated Firearms & Prop Weapons
Roof Tops, Fire Escapes, Balconies & Bridges
International Shoot
Picture Vehicles
Animals, Livestock, Pets
Water Scenes, Oceans, Rivers, Pools, Piers, Decks, etc.
Watercraft
Railroad Exposures
Airport & Aircraft
Choreographed Fights & Physical Stunts
Open Flames, Camp Fires, Fires, etc.
Pyrotechnics
Additional Insurance Coverage
Set Construction
Other Potentially Hazardous Exposures
If you checked "Other Potentially Hazardous Exposures", indicate type:
(Example: Amusement Park Rides)



When you have selected one of the above SPECIAL INSURANCE REQUESTS, please keep in mind that you must also fill out the specific questionaires. These questionaires will be located at the bottom of the "Request for Insurance" confirmation screen, and via a link on the "Request for Insurance" page. The confirmation screen will appear after you submit this form. Skipping these questionaires will cause a delay in the processing of your Location Owner's Insurance Certificate. Failure to report all SPECIAL INSURANCE situations on your shoot, can result in denial of your request.

To better serve your needs, and handle the large volume of inquiries received from the Student Film Program, we encourage you to use the contact form on our website (button below) or send a direct email to: insurance.student.film@nyu.edu.

INSURANCE DEPARTMENT CONTACT FORM

Please review this entire form before hitting the "Submit" button. It's easier to catch and change a mistake now, then after the form has been submitted.
Please note: If you make a mistake, you will be asked to resubmit your request and your request may be subject to another five business day turnaround.

By pressing the submit button, you understand that you are responsible for any deductibles or losses not covered by the above requested insurance. You also understand that completing this form does not guarantee insurance coverage for your production.


If you want a copy of this form for your records, print it before hitting the Submit button!


If you don't see a PRINT button above, use your browser to print this form for your records.
Use the Landscape setting on your printer to get the best results.