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About Us
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Medical Travel Insurance
Business Insurance
Business Owner’s Policy
Intellectual Property
Product Liability
Workers Compensation
Property Insurance
Commercial Earthquake
Employment Practices & Liability
Professional Liability Insurance
Nursing
Property Management
Architects & Engineers
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Forms
Commercial – Venue Supplemental Application
Get started by filling out this form and someone from our team will contact you shortly!
Commercial - Venue Supplemental Application
Step
1
of
10
10%
General Information
Name of applicant
*
First
Last
Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Physical Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Name of Contact
*
First
Last
Phone
Email
*
Website
Business Type?
*
Corporation
Partnership
Individual
Non-Profit
Government Entity
Does the insured own or lease the facility?
*
Own
Lease
Year business was established?
*
Number of years under current management?
*
FEIN
*
Federal Employer Identification Number
Please list all Named Insureds and their Interests
*
Named Insureds
Interests
NOTE: The First Named Insured requires common/majority ownership of each named insured.
Property Information
Year built?
*
Building construction type?
*
Frame
Non-Combustible
Modified fire resistive
Masonry
Masonry Non-Combustible
Fire resistive
Roof construction type?
*
Asphalt
Composite Asphalt Tile
Clay Tile
Wood Shingle
Please list all property on the roof. (HVAC, Etc.)
*
What is the plan for inspection and abatement?
*
Has it been inspected for lead paint and abated if necessary?
*
Yes
No
Year of roof upgrade?
*
Please provide a date or estimate of the last roofing upgrade.
Year of plumbing upgrade?
*
Please provide a date or estimate of the last plumbing upgrade.
Year of wiring upgrade?
*
Please provide a date or estimate of the last wiring upgrade.
Year of HVAC upgrade?
*
Please provide a date or estimate of the last HVAC upgrade.
Any planned renovations?
*
Yes
No
Please explain.
*
Distance to nearest fire hydrant (in feet)?
*
Distance to nearest fire department (miles)?
*
Volunteer fire department?
*
Yes
No
Is your facility a historical landmark?
*
Yes
No
Life Safety
Is the property 100% sprinklered?
*
Yes
No
Any Omega sprinkler heads?
*
Yes
No
Date of last service:
*
Month
Day
Year
Please provide a date or an estimated date
Date of last sprinkler flow test:
*
Month
Day
Year
Please provide a date or an estimated date
Number of currently tagged and operational fire extinguishers.
*
Central station fire alam?
*
Yes
No
Central station burglar alarm?
*
Yes
No
Survellance cameras?
*
Yes
No
Cooking facilities on premises?
*
Yes
No
Automatic extinguishing system over deep fat fryers, grills & stoves?
*
Yes
No
How often are hood/ducts cleaned/serviced?
*
Weekly
Bi-weekly
Monthly
Every 6 months
Yearly
Who are they cleaned by?
*
Insured
Sub-contractor
Date of last service:
*
Month
Day
Year
How many means of egress?
*
Are doors locked during performances?
*
Yes
No
Are all exits clearly marked?
*
Yes
No
Are all doors equipped with panic hardware?
*
Yes
No
Do you have Automated External Defibrillator(s) (AED)?
*
Yes
No
Are your staff members trained to use them?
*
Yes
No
Do you have backup emergency lighting and/or emergency generators in the event of a power failure?
*
Yes
No
Do you have an emergency evacuation plan?
*
Yes
No
If yes, please attach a copy.
Max. file size: 50 MB.
Evacuation procedures and floor plans posted?
*
Yes
No
Are parking lots well lit?
*
Yes
No
Security personel?
*
Yes
No
General Liability
Number of Attendees ( All Events):
*
Total Number of Employees:
*
Annual Payroll:
*
Annual Food/Restaurant Sales or receipts:
*
Annual Liquor sales/ receipts:
*
Annual Gift Shop sales/ receipts:
*
Annual Parking sales/ receipts:
*
Other Sales/ Receipts:
Who is responsible for premise defects operations?
*
Owner
Insured
Sub-contractor
Who is responsible for facility maintenance operations?
*
Owner
Insured
Sub-contractor
Who is responsible for the stage / lighting operations?
*
Owner
Insured
Sub-contractor
Who is responsible for food concessions operations?
*
Owner
Insured
Sub-contractor
Who is responsible for liquor operations?
*
Owner
Insured
Sub-contractor
Who is responsible for gift shop operations?
*
Owner
Insured
Sub-contractor
Who is responsible for parking operations?
*
Owner
Insured
Sub-contractor
Who is responsible for security operations?
*
Owner
Insured
Sub-contractor
Who is responsible for first aid operations?
*
Owner
Insured
Sub-contractor
Who is responsible for pyrotechnics / fireworks operations?
*
Owner
Insured
Sub-contractor
Who is responsible for Inflatables / amusement device operations?
*
Owner
Insured
Sub-contractor
The Indemnification / Hold Harmless wording is in favor of:
*
Insured
Sub/Tenant
Mutual
Neither
Regarding contracts and certificates of insurance with sub-contractors and tenants.
The additional insured status is in favor of:
*
Insured
Sub/Tenant
Mutual
Neither
Regarding contracts and certificates of insurance with sub-contractors and tenants.
Minimum insurance limits of $1,000,000?
*
Insured
Sub/Tenant
Mutual
Neither
Regarding contracts and certificates of insurance with sub-contractors and tenants.
A certificate of insurance required for:
*
Insured
Sub/Tenant
Mutual
Neither
Regarding contracts and certificates of insurance with sub-contractors and tenants.
Is there temporary seating?
*
Yes
No
Is the seating inspected before each performance?
*
Yes
No
What type of seating?
*
Any self-promoted or co-promoted events?
*
Yes
No
Please provide a schedule
*
Any performing arts camps?
*
Yes
No
Please attach a brochure.
Max. file size: 50 MB.
Number of days the camp is open?
*
What kind of camp?
*
Day camp
Overnight camp
Number of Campers?
*
Age ranger of campers?
*
Do you have any field trips?
*
Yes
No
Please provide a schedule
*
Are waivers with parental/guardian consent required?
*
Yes
No
Please attach a copy.
*
Max. file size: 50 MB.
Any child care services provided?
*
Yes
No
Please provide details.
*
Coverage limits requested for:
Each occurrence / Each claim:
*
General aggregate:
*
Products/ Completed Operations aggregate:
*
Personal / Advertising Injury:
*
Damage to Premises Rented to You:
*
Liquor liability:
*
Stop Gap:
*
Employee benefits liability
Limit
Number of Employees
Employed benefits administrator?
*
Yes
No
Current carrier
Carrier Name
Limit
Retroactive date
Deductible:
*
Retention limits
*
Self-Insured
Self-Funded
Other coverage limits requested?
Abuse and Molestation
Does your current insurance program include Abuse and Molestation coverage?
*
Yes
No
Do your employment and volunteer applications include questions about whether the individual has ever been convicted of any crime, including sex related or child abuse related offenses?
*
Yes
No
Are formal written procedures in place for hiring?
*
Yes
No
Please attach a copy.
*
Max. file size: 50 MB.
Do you verify employment references for employees and volunteers?
*
Yes
No
Are personal interviews conducted?
*
Yes
No
Is there a written supervision plan that monitors staff in day-to-day relationships with clients, both on and off premises?
*
Yes
No
Please attach a copy.
*
Max. file size: 50 MB.
Do you have a written crisis plan for dealing with employees, volunteers, victims, parents, authorities and the media if you have an incident of abuse?
*
Yes
No
Please attach a copy.
*
Max. file size: 50 MB.
Have any incidents resulted in an allegation of sexual abuse?
*
Yes
No
Was the case settled?
*
Yes
No
Was the case taken to trial?
*
Yes
No
Amount paid for damages to the victim.
*
Does your state allow criminal background checks?
*
Yes
No
Do you run criminal background checks prior to hire for:
*
Employees
Volunteers
Both
None
Is security the responsibility of the Insured?
*
Yes
No
Is liquor sold at venue?
*
Yes
No
Are pyrotechnics used?
*
Yes
No
Security
Who is primarily responsible (via contact) for liability coverage for security personel?
*
Insured
Municipality
Sub-contractor
Security is
*
Employed
Sub-contracted
Employed is defined as individuals being paid and supervised directly by the insured. "Contracted" is defined as the existence of a written contract with another entity for security services that his separate insurance coverage and provided a certificate naming the Insured as Additional Insured with limits equal to or greater than the Insured.
Number of unarmed security personnel:
*
Payroll of unarmed security personnel:
*
Are there any armed security personnel?
*
Yes
No
Number of armed security personnel (not including off duty police officers):
*
Payroll of armed security personnel:
*
Are there any off duty police officers?
*
Yes
No
Number of off duty police officers:
*
Payroll of off duty officers:
*
Cost of sub-contracted security personnel:
*
Maximum hours per day permitted at this and all other places of employment:
*
Please enter a number from
0
to
24
.
Maximum hours per week?
*
Please enter a number from
0
to
100
.
What are the staffing guidelines per number of patrons?
*
What are the guidelines determined by?
*
Ordinance
Statute
Industry standard
Is there a procedure to immediately report all incidents to the facility manager?
*
Yes
No
Please provide details.
*
Does the supervisor make personal contact with each security person at least once during each shift?
*
Yes
No
Please provide details.
*
Does the application require atleast three (3) personal references?
*
Yes
No
Does the hiring procedure include calling previous employers and personal refrences?
*
Yes
No
Is completion of a minimum twenty (20) hours initial training program required before deployment?
*
Yes
No
Is a minimum of ten (10) hours on-site training required?
*
Yes
No
Is a minimum of four (4) hours of annual refresher or continuing education training planned and conducted for each security employee?
*
Yes
No
Who conducts the training and what are the trainers qualifications?
*
Is each security person given a personal copy of the training/safety manual?
*
Yes
No
Please attach a copy
*
Max. file size: 50 MB.
Has each security person given management a written acknowledgement or the policies and contents?
*
Yes
No
Please attach a copy
*
Max. file size: 50 MB.
Armed Security Employees
Are the security personnel in uniform?
*
Yes
No
Please discribe the uniform:
*
Are the security personnel identified by anything other than a uniform?
*
Yes
No
Please provide an example or photograph:
Max. file size: 50 MB.
Are psychological screen profiles used?
*
Yes
No
What type?
*
Are criminal background checks completed?
*
Yes
No
What agency is utilized?
*
Please indicate any equipment carried or routinely available to security personnel
Flashlight
Handcuffs
Nightstick
Taser/Phaser
Firearms
First Aid Kit (including blood borne pathogen kit)
Chemicals (Mace, Pepper gas)
Flashlight: type, size, and construction
*
Is the nightstick police regulation?
*
Yes
Firearm caliber?
*
.357
.38
.9mm
Firearm make?
*
Colt
S&W
Ruger
Is the ammunition
*
Standard
Firearm Holster type?
*
Is the firearm ammunition approved and inspected by management or security company?
*
Yes
No
Are dogs used in your security operations?
*
Yes
No
Breed / Number of dogs
*
Discribed duties of the dog.
*
Liquor
Is the liquor license in Applicant's name?
*
Yes
No
What is the name on the license and their relationship to the insured?
*
Liquor license number:
*
Class of license:
*
Is the liquor service subcontracted to a third party?
*
Yes
No
Please provide limits of liability maintained by the sub contractor.
*
Is Applicant listed as Additional Insured under sub-contractors liquor liability coverage?
*
Yes
No
Is Contingent Liquor liability coverage requested by Insured?
*
Yes
No
Has Applicant's liquor license ever been revoked or suspended?
*
Yes
No
Please explain:
*
Has applicant incurred claims for Liquor liability during the last three (3) years?
*
Yes
No
Please explain:
*
Has any insurer cancelled or non-renewed coverage during the last three (3) years?
*
Yes
No
Please explain:
*
Has applicant ever been fined by Alcoholic Beverage Control or other governmental regulators?
*
Yes
No
Please explain:
*
Type of beverages sold?
*
Liquor annual gross sales
*
Food annual gross sales
*
Other annual gross sales
Are patrons allowed to carry alcoholic beverages onto the premises?
*
Yes
No
What type of beverages?
*
Do you exercise the right to search and seizure contraband items?
*
Yes
No
How do you notify the public of this?
*
Do you maintain security personnel at entry check points?
*
Yes
No
What type of security?
*
Are alcohol sales and consumption contained within one fixed site, or are booths/stands located throughout the event site?
*
Number of servers?
Are they professional servers?
*
Yes
No
Are they volunteer servers?
*
Yes
No
Do the servers receive any type of alcohol awareness training?
*
Yes
No
Please discribe:
*
Median age of liquor customers:
*
21-25
25-30
30-40
40 and over
Are minors allowed to enter the location where alcohol is being served?
*
Yes
No
Please Explain how ID's are checked:
*
What type of officers are present at the site of alcohol sales?
*
Uniformed police officers
Undercover police officers
Private security officers
None
Average number of officers present at site:
*
Are rules and regulations clearly displayed for patrons viewing?
*
Yes
No
Please discribe:
*
Is there a limit placed on the quantity of alcoholic beverages purchased at one time?
*
Yes
No
Please explain:
*
Is the parking area patrolled to prevent intoxicated drivers from leaving the premises?
*
Yes
No
Is there any type of designated driver program?
*
Yes
No
Limit of liquor liability coverage requested?
*
Pyrotechnics
Limit of liability requested?
*
Please provide a discription of events:
*
Please list the location events and dates
*
Location
Date
Who is the authority having jurisdiction over the use of pyrotechnics at your facility?
*
Local fire department
State fire marshal
What permit process must be followed prior to use of pyrotechnics at your facility?
*
Have you staged pyrotechnic displays before?
*
Yes
No
Please list any claims/losses that have occurred and the amount of loss
Discription
Date of Occurrence
Amount of Loss
Who will be the pyrotechnics operator?
*
Name Insured
Contractor
List names of people shooting and describe their experience
*
Name
Experience
NOTE: This coverage will exclude bodily injury liability to the fireworks shooter.
Where are the pyrotechnics stored when not in use?
*
Does it meet federal/state storage regulations?
*
Yes
No
Describe the type of show and amount of pyrotechnics used in recurring events
*
Describe what fire prevention and suppression measures are taken to support the pyrotechnic loading and firing process
*
Does the applicant secure proper pyrotechnic permits for each event?
*
Yes
No
Are the shooters listed above licensed for pyrotechnics?
*
Yes
No
Name of Operator
*
First
Last
Is there and agreement with the contractor?
*
Yes
No
Please attach a copy of the agreement
*
Max. file size: 50 MB.
Will liability coverage be provided by the pyrotechnics contractor?
*
Yes
No
Please indicate limits of coverage provided:
*
$1,000,000
Greater than $1,000,000
Please attach a copy of certificate of insurance including any additional insured listing
*
Max. file size: 50 MB.
Do you confirm that the contractor has secured the proper pyrotechnic permits for each event?
*
Yes
No
Describe what fire prevention and suppression measures are taken to support the pyrotechnic loading and firing process
*
Do you allow tenant users (including temporary tenant users) to conduct pyrotechnic displays either themselves or through a contractor?
*
Yes
No
Does the tenant lease/ use agreement indicate that pyrotechnic displays are not permitted
*
Yes
No
What steps are taken to ensure that the appropriate permits are granted, appropriate fire safety codes are met, and that insurance has been obtained from either the tenant or the tenant's contractor which lists the Applicant as an additional insured?
*
Are events with pyrotechnics held :
*
Indoors
Outdoors
Both
What type of pyrotechnics will be displayed (as defined in NFPA code 1126)?
*
Aerial Shells
Concussion Effects
Flash Pots
Mines
Wheels
Airbursts
Concussion mortars
Flashpower
Mortars
Salutes
Black Powder
Saxon
Gerbs
Rockets
Comets
Flares
Integrals Mortars
Electric matches
Waterfall, Falls, Park Curtains
Are the events in compliance with NFPA 1123 or 1126 (Code for fireworks display)
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Yes
No
Is there fencing to keep spectators away from restricted areas during the fireworks shooting?
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Yes
No
Distance of spectator fencing from launch site?
*
Distance of spectator parking from launch site?
*
Distance of closest building or structure from launch site?
*
Will there be firefighting equipment on site during the event?
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Yes
No
Distance to nearest fire station?
*
Will you have an ambulance on site?
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Yes
No
What is the estimated response time of an ambulance?
*
Distance to nearest Medical center?
*
Are the events in comliance with NFPA 1126 (Standard code for the use of pyrotechnics before a proximate audience
*
Yes
No
Is the facility sprinklered?
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Yes
No
What other form(s) of firefighting equipment is available at the facility?
*
Does the Facility have an emergency evacuation plan?
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Yes
No
How often is the staff drilled on emergency evacuation?
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Every event
Weekly
Bi-weekly
Monthly
Every 6 months
Yearly
Number or accessible (not locked) emergency exits at the facility:
*
Maximum capacity of the facility:
*
What steps are taken to inform patrons of the locations of all emergency exits?
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Has the fire marshal approved the use of pyrotechnics at the facility?
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Yes
No
As of what date?
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Month
Day
Year
Hired & Non-owned Auto
Does the Applicant have any owned automobiles?
*
Yes
No
NOTE: If Applicant has owned autos the hired car and non-owned auto coverage should be placed with the automobile carrier.
Does the applicant allow employees to use their own personal vehicles for business purposes?
*
Yes
No
How often?
*
Daily
Weekly
Monthly
How many employees use their own personal vehicles?
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Do you confirm that all employees who regularly use their cars for business purposes carry minimum personal auto limits?
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Yes
No
What minimum limits are required?
*
Do you obtain Motor Vehicle Reports?
*
Yes
No
How often?
*
Annually
Every other year?
Please provide the approximate cost of hire for all hired or leased autos during the course of the policy period:
*
Limits of coverage required?
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$100,000
$300,000
$500,000
$1,000,000
Is hired auto physical damage required?
*
Yes
No
What is the maximum value of hired vehicle you would like insured
*
NOTE: Physical Damage deductibles provided $100 comprehensive/ $1,000 collision.
Email
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