Home | Client Services | Claims | Contact Us




  A Service of Supple-Merrill & Driscoll, Inc.




 Non-Workers Compensation Claim Reporting Instructions

  1. Claims should be reported immediately.

  2. Please provide as much information as possible to expedite the claim reporting.

  3. Please include a narrative of the occurrence leading to the loss.

  4. Please complete this form for each loss. 

This is a secure application.  Strong cryptography is implemented via the Secure Sockets Layer protocol.  Our Privacy Policy.



( indicates required information)

Policyholder Information

Name of Individual/Company/Organization:
Full Name of Person to Contact:


We will never rent, sell, or share your email address.

Full Name of Person Submitting Claim:


Policy Information
Production Title / Event Name:
Quote / Policy Number:
Policy Type:


Loss Details

Date of Loss:

Type of Loss:

If Other

Report Number:

If Any

I.E. Fire, Police, Etc.

Estimated Loss Value:


Automobile Loss
Name of Vehicle Owner:
Year, Make, Model & License of Damaged Vehicle:

Rented Vehicle Non-Owned Vehicle

Driver Name:
Driver License Number & State of Issue:
Driver Date of Birth:


Location of Loss
Name of Location:
Street Address:
City, State: ,
Zip/Postal Code:

Describe Location of Loss if Not at Specific Street Address:




Loss Narrative
Please provide a detailed description of the events surrounding the loss below.






Home | About Us | Client Services | Sitemap | Claims | Blog | Contact Us

Productions | Entertainment Services | Events | Floaters | Errors & Omissions | Instant Quotes


ProductionInsurance.com is the entertainment division of Supple-Merrill & Driscoll, Inc.  California License 0517777.

Copyright 2017.  All rights reserved.  Terms of Use | Privacy Policy