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News CEO Zain Jeewanjee Interview on WomenNow TV   Multimedia Production E&O Name:* (first) (last) Applicant Type: -----Applicant Type----- Individual Corporation Partnership LLC Applicant Ownership: Publicaly traded Privately held Mailing Address:       (street)         (City) ---Select a state--- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming (zip)       Telephone: Applicant State of Formation: Email: Number of Employees: Applicant is more than 30% owned by a publicaly traded company: No Yes Aggregate limit sought: $1 mil $3 mil $5 mil Per claim limit sought: $1 mil $3 mil $5 mil Retention: $10,000 $25,000 $50,000 $100,000 Production Information Title/Name of Production: Please provide the synopsis of the Named Production Named Production Budget: Check each that apply in whole or in part to the named production and provide requested information where applicable Motion Picture: for Theatrical Release for Television Release for Cable/Satellite/Wireless Release for DVD/Video Tape Release for Internet Release for Game Release Musical/Comedy Dramatic Documantry Unotherized Biography Corporate/Government Film Children/Animation Historical/Relegious Comedy Televison Program: Dramatic Musical,Comedy or Variety Special Series Pilot News Documentary Docu-drama Unauthorized Biography Investigative Infomerical Children/Animation Quiz/Panel Reality Radio Program: Music Format Talk Format Shock Jock News Format Hidden microphones used during program Prank phone calls made during program Relegious Educational Investigative Station sponors musical events Stations sponsors contests Streamed on Internet Sports Consumers Advocacy Initial Release or Air Date: Clearence, Lisences, Consents and Releases Have all performers who will appear in the Named Production entered into a written performance agreement with the applicant related to their appearance? Yes No Has the applicant obtainer will obtain a lisence, consent or release from those persons, animals or characters who appear in the Named Production without a written performance agreement? Yes No In the past three years, have you been given notice of any potential infringement of another party's intellectual propert(IP) rights, including without limitation,copyright, or trademark infringement? Yes No Do you require freelancers,independent contractors, musicians, composers or others who procide you with content:   A. to assign or lisence you their rights to the contents? Yes No B. to warrant that their work does not violate another party's rights? Yes No C. to indemnify you should an IP infringement claim be made against you? Yes No Will the requirements outlined above be specifically met with regards to the Named Production? Yes No Representations and Warranties Has any insurance carrier ever cancelled or non-renewed a policy of yours that provided the same or similar coverage as the insurance sought (Missouri Applicants Need Not Reply)? Yes No Are you aware of any claims or legal proceddings made or commenced against you or any of your officers, members, partners within the last five years for: invasion of privacy or false light intellectual property infringement defamation a claim arising out of the alleged submission of any ideas, story line or script? Yes No Are you aware of any claim made or threatened claim made against you or any of your officers, members, partners ariding out of or related to the Named Production ? Yes No Applicant agrees to obtain from third parties from whom it will obtain services or content for the Named Production written warranties and idemnification against claims arising out of the use of such services or contents? Agree Disagree Applicant agrees to use its best efforts to determine whether any content to be used by the Named Production is protected by law, and where necessary, to obtain from parties owing rights therein the right to use the same in connection with the Named Production? Agree Disagree Applicant agrees that as a condition precedent to coverage for claims brought by a claimant who either performed or appeared in the Named Production or a climant who provided either content or services for the Named Production, the applicant must have prior to the broadcast or distribution of the Named Production a signed agreement or a signed release fropm such climant agreeing to the respective appearance, performance, use of contents, or use of services made in the Named Production? Agree Disagree Applicant agrees that as a condition precedent to coverage for a claim brought by a climant based on alleged unauthorized use of title, a title search for Named Production will have been conducted by a title clearence service and a title report submitted to the carrier prior to the occurance of said claim? Agree Disagree

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