WeddingShield by Cook Insurance Group Survey

1.Bride's name (First & Last)

2.Groom's name (First & Last)

3.wedding date

Date / Time

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

4.Your phone number

5.Your email address

6.number of guests

7.name of ceremony venue

8.city of ceremony venue

9.name of reception venue

10.city of reception venue

CORE COVERAGE

Level	Premium	Cancl/postpone	Addtl Exp	Video/Photo	Gifts	Attire	Jewelry	Deposits
1	$160	$7,500	$1,500	$1,500	$1,000	$,1500	$1,000	$,1000
2	$210	$1,500	$3,000	$2,000	$1,500	$2,000	$1,500	$1,500
3	$255	$2,500	$5,000	$2,500	$2,000	$2,500	$2,000	$2,000
4	$300	$3,500	$7,000	$3,000	$2,500	$3,000	$2,500	$2,500
5	$355	$50,000	$10,000	$3,500	$3,000	$3,500	$3,000	$3,000
6	$500	$75,000	$15,000	$4,500	$4,000	$4,500	$4,000	$4,000
7	$615	$100,000	$20,000	$6,000	$5,500	$6,000	$5,500	$5,500
8	$735	$125,000	$25,000	$7,500	$7,000	$7,500	$,7,000	$7,000
9	$870	$ 150,000	$30,000	$9,000	$8,500	$9,000	$8,500	$8,500

Higher limits may be available with underwriting approval. Travel advisory for Mexico: Core Coverage levels 1-9 available in applicable areas.

12.Choose Level of Liability coverage

$0 - Liability coverage is not desired.

$75 - $500,000 per Occurrence/$500,000 General Aggregate Liability with Property Damage included in the occurrence limit

$100 - $1,000,000 per Occurrence/$1,000,000 General Aggregate Liability with Property Damage included in the occurrence limit

$160 - $1,000,000 per Occurrence/$2,000,000 General Aggregate Liability with Property Damage included in the occurrence limit

$213 - $2,000,000 per Occurrence/$2,000,000 General Aggregate Liability with Property Damage included in the occurrence limit

Higher liability limits may be available with underwriting approval. Please contact us for additional information.

13.Is liquor going to be served

yes

no

14.Bungee operations/equipment; dunk tanks; fire pits/bonfires; fireworks/pyrotechnic devices (incl. hot sparklers & sky lanterns); inflatable recreational devices (incl. bouncy houses); live animals/petting zoos; mechanical amusement devices/rides; participatory sporting events; or swimming/watersports.

YES

NO

15.If 14 is YES explain type of special activity else state NONE

16.Will your rehearsal occur within 48 hours before your wedding, if so it can be included. Would you like it included?

Yes

No

17.If 16 is YES add name and city of rehearsal venue else state none

18.If your rehearsal dinner occurs within 48 hours of the wedding it can be covered as well. Would you like it covered?

Yes

No

19.If 18 is YES add the name and location of the dinner else state NONE

20.If your brunch occurs between 9:00 AM and 3:00 PM the day after your Event Date, it can be included. Would you like it covered?

Yes

No

21.If 20 is YES add the name and location of the brunch else state NONE

22.Are you using an Event Coordinator?

Yes

No

23.If 22 is YES add the name and email of the coordinator else state NONE

WeddingShield by Cook Insurance Group

quote information