• Gun Club Insurance Questionnaire

  • Applicant is:

  • General Information (Gun Club, Hunt Club, Hunting Preserve, Hunting Lodge, Hunting Guide, Range (Indoor and Outdoor), Sporting Club, Archery Club, Sporting Clays, Trap, Skeet, Five-Stand, Rod Club) - Gun Sales Ineligible

  • 1. Please indicate if you have or use any of the following:

  • 1a. Acreage – Leased
  • 1b. Acreage – Owned
  • 1c. Archery Range
  • 1d. ATV - Guided
  • 1e. ATV - Unguided
  • 1f. Big Game Hunting
  • 1g. Boats
  • 1h. Club Members
  • 1i. Clubhouse
  • 1j. Docks & Piers
  • 1k. Farming: Crops, Livestock
  • 1l. Lakes or Ponds
  • 1m. Liquor Sales
  • 1n. Lodging
  • 1o. Range (Rifle & Pistol) – Indoors
  • 1p. Range (Rifle & Pistol) – Outdoors
  • 1q. Restaurant
  • 1r. Retail Store
  • 1s. Sporting Clay
  • 1t. Trap & Skeet
  • 1u. Upland Bird Hunting
  • 1v. Waterfowl Hunting
  • 1w. Youth Programs

  • GENERAL INFORMATION (continued)

  • 2. Check all that apply to your operation:
  • 4. Do you require participants to sign a waiver of liability? (If yes, please attach a copy)
  • 5. Do you have a brochure? (If yes, please attach a copy)
  • 8. Are any operations conducted outside the following states? (Tennessee, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, North Carolina, Ohio, Virginia, and Wisconsin)
  • 9. Do you hire guides as subcontractors?
  • 9a. If yes, do you obtain certificates of insurance?
  • 9b. Do you require contractors to name you as additional insured on their policy?

  • 10. Attach your list of safety guidelines

  • Rows
  • 12. Does the insured allow individuals to use fully automatic weapons on their premises?

  • HUNTING INFORMATION

  • 1. Do you offer hunting activities? (If yes, please answer the following questions.)
  • 4. Are tree stands used?
  • 4a. If yes, do you require a full body harness?
  • 4b. If yes, do you give instructions on the safe way of getting into and out of the stand?
  • 5. Are shooting platforms used? (A shooting platform is free standing and not near a tree.) If yes, please provide photo.
  • Rows
  • 7. If ATVs and/or snowmobiles are used, are helmets required when riding?
  • 8. Are any of the above rented to others for other than hunting purposes?
  • 9. Are all hunters required to wear blaze orange when mandated by State law?
  • 10. Are ground hunting blinds marked and/or covered with the minimum amount of blaze orange requirements when mandated by State law?
  • 11. Are all hunters required to unload their firearms when traveling by motorized vehicle, boat, ATV/UTV, snowmobile, or saddle animal?

  • GUIDE INFORMATION

  • 1. Do you offer guide services? (If yes, please answer the following questions.)
  • Rows

  • CLUBHOUSE/LODGING INFORMATION

  • 1. Do you have a clubhouse or offer lodging? (If yes, please answer the following questions.)
  • 5. Do all units/rooms have smoke alarms?
  • 8. Is there a caretaker on premise year round?
  • 9. Do you have a swimming pool or swimming area?
  • 9a. If yes, do you have a diving board?
  • 10. Is alcohol served or allowed on the premise?
  • 11. Commercial cooking? (Deep fryers or indoor grill)
  • 11a. If yes, protected by extinguishing system meeting UL 300 standards?
  • 11b. If yes, do you have a semi-annual servicing/cleaning contract for the extinguishing system?

  • SHOOTING RANGE INFORMATION

  • 1. Do you have shooting ranges? (If yes, please answer the following questions.)
  • 2. Is a rangemaster/supervisor on premise during shooting hours?
  • 3. Are range rules and safety guidelines posted in a conspicuous manner? (If yes, please provide a copy of the range rules and a copy of the waiver used for range participants.)
  • 5. Is the premise secured and locked when not operating?
  • 7. Are the ranges approved by the NRA or the state department of natural resources?

  • WATERCRAFT LIABILITY INFORMATION

  • 1. Do you have watercraft exposure? (If yes, please answer the following questions.)
  • 3. On what type of body of water does the use take place?
  • 4. Are life vests (PFD’s) required?
  • 4a. If yes, do you provide the life vests?

  • SALES AND REVENUE INFORMATION

  • 1. Do you raise, sell or train dogs for anything other than bird hunting?
  • 2. Do you raise game birds for sale to others (preserves, restaurants, etc.)?
  • 3. Do you sell any handguns?
  • 4. Do you sell used guns?
  • 5. Do you host gun shows?
  • 5a. If yes, do you complete an NCIS background check of the buyer prior to the sale?
  • 5b. If yes, do you have a protocol in place that ensures the firearms brought onto the premises by vendors are checked at the door to confirm they are not loaded, that they are tied in a manner to prevent firing, and that the magazines are removed and unloaded?
  • Rows

  • PROPERTY INSURANCE

  • 1. Do you need Building and/or Content Coverage? (If yes, complete chart below.)
  • Rows
  • 2. Do you need Equipment Coverage?
  • 2a. If yes, total value to insure for?
  • Rows

  • COMMERCIAL AUTOMOBILE INSURANCE

  • 1. Does the business title any automobiles or other operating vehicles in the business name?
  • 2. Is insurance coverage needed for owned automobiles?
  • Rows
  • Rows
  • 3. Do any of the employees, owners or officers drive personally owned automobiles/other vehicles in the course of their work?
  • 3b. Do you verify they have liability coverage?

  • COMMERCIAL CRIME

  • 1. Do you desire coverage for Crime (Employee Dishonesty, Money, Forgery)?

  • OTHER COVERAGES

  • 1. Do you need a Commercial Umbrella?
  • 2. Do you need Workers Compensation? (If yes, please contact Kevin Morency.)
  • 3. Do you need Directors and Officers Liability Coverage? (If yes, please contact Kevin Morency.)

  • SIGNATURE

  • The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.

  • Questions? 877-244-9090
    Kevin Morency |  kmorency@morencyinsurance.com 

    Morency & Associates Inc.,
    141 New Shackle Island Rd, Hendersonville, TN 37075
    Fax: 615-452-6580

    https://insurancegunclub.com/

  • Should be Empty: