Inflatable Insurance

General Information

First Name *

Last Name *

Corporate or LLC Name *

FEIN # or DBA Name

Mailing Address *

City *

State / Province *

ZIP / Postal Code *

Location Address *

Location City, State, Zip Code *

Primary Phone Number *

Cell Phone Number *

Fax Number

E-Mail Address *

Date Business Started Under Current Ownership *

Current Insurance

Have you been previously insured? *

Current Insurance Provider

Nature of Business

Please select the option that best describes the nature of your operation *

If other, please describe other business operations:

Revenue Breakdown

Revenue from misc rentals and supplies (Mobile Game Shows, Carnival Type Game Booths, Cash Cubes, Video Games, Pin Ball Machines, Skee or Skeet Ball, Putting Challenge, Foosball, Air Hockey, Pop A Shot* *

*Also: Football Challenge, Pool Tables, Spin Art Pictures, Oriental Name Writing, Rice Art Jewelry, Candle/Sand/Candy Art

*Also: Wax Hands, DJ/Sound/Video Equip., Photo Booths, Disco Ball, Old TIme Photos, Table/Yard Bowling, Simulators w/o motion, Hi-Striker, Batting Cage Game with Tee, Advertising Signs

Revenue from simple mechanicals (Trikes, small & large mechanical devices, Bumper Boats and Cars, Trackless Trains *

Revenue from interactive inflatables (air filled amusements and devices such as Slides, Bounce Houses, Combo Bounce Houses with Slides, Obstacle Courses) *

Revenue from interactive devices (direct interaction between participants such as Paint Ball, Dunk Tanks, Mini Golf Driving Ranges, Putting Greens* *

*Also: Boxing Games, Lazer Tag, Hay Rides, Simulators with Motion, Velcro Wall

Revenue from Physical Activity Devices (Euro Bouncers/Bungee, Rock Walls WITH Auto Belay, Jousts, Jacobs Ladder, Bungee Runs *

Revenue from physical activity devices II (Rock Walls WITHOUT Auto Belay Systems, Electric Bulls, Go Carts, Haunted Attractions, Batting Cage with Pitching Machine *

Revenue from physical activity devices III (Orbitrons with motors (only) Sumo Suit, and simiilar - Air Bots, etc.) *

Revenue from entertainment services (Clowns, DJ, Magicians, etc.) *

Are they subcontracted or Employees?

Subcontracted
Employees

Are background checks done?

Yes
No

If subcontracted, do you get copies of their certificate with limits equal to yours?

Yes
No

Revenue from food and beverage products and rentals (Hot Dog Cookers, Nacho/Popcorn Machines, Snow Cone/Frozen Drink Machines, Chocolate Fountains, Warm Pretzel/Cotton Candy Machines, Ice Cream Sundae Bar *

Revenue from tables, tents and chairs *

Revenue from restaurants & snack bars *

Revenue from catering *

Revenue from party planning *

Revenue from other - Please Describe *

Revenue from subcontracted devices (please also describe) *

If subcontracted, do you get copies of their certificate with limits equal to yours?

Yes
No

Revenue from Hydraulic Bull, Orbitron without Motor, Zorb balls, Water Balls, Hamster Balls *

TOTAL REVENUES *

Inflatable Information

Height Measured from Ground to Platform

Number of Small Slides 15' and under *

Number of Medium Slides over 15' to 22' *

Number of Large Slides over 22' to 26' *

Number of Giant Slides over 26' *

Number of Combo Slides with Bouncer *

Rockwall Information

Do you have a rockwall? *

Is the Rockwall Supervised by a trained operator at all times?

Yes
No

Is the tool loop cut off from the safety harness?

Yes
No

When the Rockwall is not is use, how and where do you store it?

How often are the cables replaced?

Is the Rockwall manual or auto belay?

Other Equipment

Do you have a bungee trampoline? *

Obstacle Course Information

Please include Length, Width, and Height of Obstacle Courses and number of each

Small: H___ x W___ x L___ and number of each *

Medium: H___x W___x L___ and number of each *

Large: H___x W___ x L___ and number of each *

Indoor Fun Facility Information

Do you have an indoor fun facility? *

How many rooms & total square footage

Is it in a stripmall or other building?

Yes
No

Any drop offs?

Yes
No

Must parents stay with child?

Yes
No

Hours of operation, Monday - Friday

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Hours of operation, Saturday

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Hours of operation, Sunday

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Is an attendant always there?

Yes
No

Do you have:

Day Care
After School Program
Camps
Trips Off Site
Party Rooms
Customers bring own food and beverage
Customers bring alcohol
Liquor License
Alcohol Served

Mechanical Bull Information

Do you have a mechanical bull? *

Is Mechanical Bull hydraulic drive or electric?

Hydraulic Drive
Electric

Is Mechanical Bull located at a fixed site or mobile?

Fixed Site
Mobile

Please check all venues where Mechanical Bull will be operated

Bars or Taverns
Private Parties
Rodeos
Carnivals or Fairs
Competitions
Other - please see below

Please describe other venues of operation

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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