WEB COPY

Entertainment Partners | 2835 N. Naomi Street, Burbank, CA 91504-2024 Phone: 800.955.4878 | Fax: 818.559.3283 | www.ep.com

Insurance Requirements and Questionnaire

If any of the boxes below ARE checked, please continue completing the rest of this form,as these activities require prior approval by EP.

If NONE of the below activities apply to your production, you do not need to fill out thisform. However, a certificate of insurance is always required, so please send the InsuranceRequirements on Page 3 to your insurance broker. The certificate of insurance should beemailed to certs@ep.com. NOTE: Payroll cannot be processed until the certificate is receivedand approved by EP.

If any of the boxed items are added to your production at a later date, please contactinsurance@ep.com or call 800.955.4878 to request the required approval.

NOTE: EP does not pay or provide Workers’ Compensation for aircraft pilots, or on-camera talent, or participants engaged in risky production activities without prior approval by EP.

Please check ALL that apply to your production:

Aircraft Athletes/Dancers Foreign Pyrotechnics

Scuba Diving Skydiving Stunts Watercraft

Weapons/Live Ammunition Wild Animals

Other Hazardous Activities not listed above:

U.S. Government Contract Project

Any Foreign Countries listed here: http://www.treasury.gov/resource-center/sanctions/Programs/Pages/Programs.aspx

Production Company: ________________________________________________________________

Production Title: ____________________________________________________________________

Production Contact Name: _________________________________ Phone: ___________________

Email: _____________________________________________________________________________

Your Insurance Broker’s Name: _____________________________ Phone: ___________________

Email: _____________________________________________________________________________

Dates for Above Activities:

Locations:

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Insurance Requirements and Questionnaire WEB COPY Updated January 2014 Page 2 of 4

Entertainment Partners | 2835 N. Naomi Street, Burbank, CA 91504-2024 Phone: 800.955.4878 | Fax: 818.559.3283 | www.ep.com

Description of Activities:

Number of EP Employees Involved (include job functions):

Names of Stunt/Safety Coordinators:

Name of Nearest Emergency Hospital:

Number of Miles:

Description of Safety Precautions and Experience of Those Participating in Hazardous Activities:

Please click the Email Form button below to send your completed form by email to insurance@ep.com.

Or, you may FAX the completed form to our Risk Management team at 818.559.3283.

Insurance Requirements and Questionnaire WEB COPY Updated January 2014 Page 3 of 4

Entertainment Partners | 2835 N. Naomi Street, Burbank, CA 91504-2024 Phone: 800.955.4878 | Fax: 818.559.3283 | www.ep.com

Insurance Requirements for EP Clients Please send this to your insurance broker and forward your certificate of insurance to certs@ep.com (see sample certificate on next page). NOTE: Payroll cannot be processed until the certificate is received and approved by EP. Please note you must request prior approval of hazardous activities by contacting insurance@ep.com or by calling 800.955.4878.

1. Certificate Holder and Additional InsuredENTERTAINMENT PARTNERS, ITS PARENT, SUBSIDIARIES, RELATED AND AFFILIATEDCOMPANIES, ITS OFFICERS, DIRECTORS, AGENTS AND EMPLOYEES2835 N. Naomi StreetBurbank, CA 91504-2024ATTN: certs@ep.com

2. Notice of Cancellation/Carrier RatingCertificate Holder shall receive 30 Days Notice of Cancellation or Material Change on all policiesshown below. All carriers must have a Best Rating of A+ or better.

3. Commercial General Liability InsuranceLimit: $1,000,000 Limit per Occurrence

4. Commercial Auto Liability InsuranceLimit: $1,000,000 Limit per OccurrenceForms: Hired and Non-Owned Auto LiabilityNote: Owned Auto Liability is required if the Production owns vehicles.

5. Foreign Liability Insurance (waived if all activities are in the U.S., its possessions, or Canada)Limit: $1,000,000 Limit for Bodily Injury & Property Damage

6. Aircraft Coverage (waived if no aircraft activities are involved)NOTE: EP cannot pay aircraft pilots unless acceptable Aircraft Certificates of Insurance are approvedby EP Risk Management PRIOR to flight activities.In order for EP to pay the pilot, Production must provide: Non-Owned Aircraft Liability with$10,000,000 Limit per Occurrence for Bodily Injury (Including Passengers) & Property Damage(Including Damage to the Aircraft), naming EP as Additional Insured per item 1aboveIf EP is NOT paying the pilot, Aircraft Owner or Supplier must provide: Aircraft Liability with a limit of$10,000,000 Limit per Occurrence (Including Passengers) and Hull coverage with a limit sufficient tocover the value of the aircraft, naming EP as Additional Insured per item 1 above. Must includeWaiver of Subrogation with respect to Hull Coverage.

7. Non-Owned Watercraft Coverage (waived if no watercraft activities are involved)Limit: $10,000,000 Limit per Occurrence, including Hull coverage sufficient to cover the value of thevessel(s). In some cases, lower limits may be sufficient, depending on production activities.

8. SPECIAL NOTEProductions should maintain their own Workers’ Compensation policy to cover interns, volunteers,people who are injured while auditioning or rehearsing (prior to employment through EP), foreignhires working in foreign countries, and others who are not insured through EP.

If you have questions, please contact Bob Remmel (818.955.6051), Robyn Ortiz (818.955.6199), or Tina Zargarian (818.955.6386). Please email your certificate to certs@ep.com or FAX to 818.559.3283.

ENTERTAINMENT PARTNERS, ITS PARENT, SUBSIDIARIES,RELATED AND AFFILIATED COMPANIES, ITS OFFICERS,DIRECTORS, AGENTS AND EMPLOYEES2835 N. NAOMI ST.BURBANK, CA 91504ATTN: CERTS@EP.COM NAME OF AUTHORIZED REPRESENTATIVE