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CEO Zain Jeewanjee
Interview on WomenNow TV
Short Term Production
Please answer all questions to prevent a delay in processing your quote request.
If you have any questions call us at 408.286.1111 for help or fax at 408.997.7890
Contact Information
Company Name:
Business Entity:
Company Address:



Contact Person:
Cell Phone:
Email Address:
Qualification Questions
Any: Stunts,Pyrotechnics, Aircraft, Boats, Animals, Race, Tracks, Race Courses, Helicopters, Motorbikes, Snowmobiles, Blanks, Squibs, Guns, Rap Music?
Yes No
Is coverage required outside of the U.S. and Canada?
Yes No
Any prior production with any losses of any kind?
Yes No
Production Details
Type of Production:
Title of Production:
Budget (Gross Production Cost):
Brief Description/Synopsis of Shoot:
Cities and States of Shooting Locations:
Coverage Start Date:  
Coverage End Date:  
For Music Vedios Only
Type of Music:
Music Decade:
Artist Name:
Coverage Options
Rented Equipment Limit: $
Props, Sets, Wardrobe Limit: $
Negative Film/Faulty Stock:
Extra Expense:
Third Party Property Damage: None 250,000
500,000 1,000,000
General Liability
Occurance/Aggregate Limit: $1,000,000 / $1,000,000
$1,000,000 / $2,000,000
$2,000,000 / $2,000,000
$3,000,000 / $3,000,000
$4,000,000 / $4,000,000
$5,000,000 / $5,000,000
Blanket Additional Inusred/Certificates of Insurance: Automatically Included
City Certificates: Include Exclude
Waiver of Subrogation: Include Exclude
Hired and Non-Owned Auto
Liability: $1,000,000
Physical Damage $125,000 per vehicle, $500,000 aggregate Include Exclude
Workers Compensation
Workers Comp required by SAG?: Yes No
Number of Cast:
Number of Crew:
Number of Volunteers:
Payroll W-2:
Payroll 1099:
Payroll Deffered:
Payroll Other:
Payroll Company Name(if any):
Officer 1 Name and Title:  
          (Name)                    (Title)
Officer 2 Name and Title:  
          (Name)                    (Title)
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Copyright 2005-2015 Jeewanjee Insurance Agency All rights reserved

California Lic # 0697055
1494 Hamilton Ave #101, San Jose, CA 95125