Market Renewal Application
Effective Date
Expiration Date

Administrators - Override Policy Dates

Over $100,000: We will contact you with a customized price quote

Policy Holder Information

Contact & Mailing Information

Business Information

Are there other operations or special events outside the scope of regular farmers market/craft fair type activities? *

Market History & Information

It is mandatory that markets require their vendors to maintain a commercial general liability policy. Policy limit should be a minimum of 1 million per occurrence with a 2 million aggregate limit. Each vendor policy needs to list the market as an additional insured or contain a blanket additional insured endorsement and provide the market with a certificate of insurance confirming coverage. I agree to upload all vendor certificates to Campbell Risk Management to assist with verification of proper coverage as soon as available and convenient. A link will be emailed to you for this purpose. *

It is mandatory that markets require all their vendors to have insurance and to list the market as an additional insured. This form will not process if you continue.
If you have questions, you can reach us at 317-848-9075.

Does the market lend, lease, or rent equipment to others? *

Totals

User Registration

Payment Information

Please make sure to enter the correct billing address of the cardholder. An incorrect billing address can result in a problem processing your payment information.

Credit Card Billing Address *
Credit Card Billing Address
Billing Street Address
City
State/Province
Zip/Postal
Credit Card Number *
Credit Card Number
Credit Card Number
Exp Month
Exp Year

Renewal Confirmation

The information above is accurate. Please renew my policy with the information above. *

Terms & Conditions

By filling out the preceding form, any farmers market or vendor is eligible to become a member of the FM&V RPG, managed by Campbell Risk Management.

RISK PURCHASING GROUP NOTICE

This FM & V Purchasing Group Policy is protected by the insurance insolvency guaranty fund in the state of Illinois. You may also have rights under your state of domicile's insurance solvency guaranty fund. However, the insurer or Risk Purchasing Group may not be subject to all the insurance laws and rules of your state of domicile.

IMPORTANT NOTICE REGARDING RISK PURCHASING GROUPS

Disclosure Pursuant to Federal Law Regarding Purchasing Groups [15 U.S.C. SEC. 3901, et seq] FM & V Purchasing Group is a "Risk Purchasing Group", as defined under Federal law, formed to purchase liability insurance on a group basis for its Members to cover the similar or related liability exposure(s) to which the Members of the Risk Purchasing Group are exposed by virtue of their related, similar, or common businesses or services. Members do not share limits and each member is provided with its own policy and/or evidence of insurance.

Read Terms & Conditions

Acceptance of Terms and Conditions
After purchasing this policy, you can add as many additional insureds as needed at no extra cost.