Bowling Center Insurance Questionnaire

Bowling Center Insurance Questionnaire
Applicant's Name:*
Address:*
Mailing Address
Address (cont):*
Mailing Address - continued
Contact:*
Email*
Telephone:*
Website
Fax:
Applicant is:

IndividualPartnershipCorporationOther (specify)Other
Current Carrier:
Expiration Date:
Limits: ($)
Premium: ($)
Deductible: ($)
Bowling Teams | Bowling Clubs | Bowling Leagues | Bowling Camps | Bowling Clinics | Bowling Tournaments | Races
GENERAL INFORMATION
1. Liability Coverage (check coverage desired):

General Liability – including injuries to participants
GL Occurrence Limits desired:
GL Aggregate Limits desired:
2. Do you want Abuse & Molestation coverage (available for youth leagues)?

YesNo
3. Participants' medical payments: (choose one)

$1,000$2,500
4. Please list locations and buildings at each location (List additional locations on separate page)
Location 1: Address and number of buildings
Location 2: Address and number of buildings
OPERATIONS
1. Number of years THIS insured has been operating a bowling center at THIS location:

2. Hours of operation during:

3. Does the bar remain open after the bowling lanes have closed?

YesNo
4. Does the insured inspect and disinfect rental bowling shoes after each use?

YesNo

5. Annual gross sales from: (Please provide 2 most recent years of income statements and balance sheets.)

	Annual Gross Sales ($)
a. Bowling
b. Pro Shop - Rental income if leased out
c. Liquor
d. Food
e. Entertainment (ie concerts, bands, dancing, etc.)
f. Other (Describe below)

5fi. Describe "Other" activities:
6. What percentage of the insured's business is generated from bowling leagues?
6a. Is there child care for league bowlers?

YesNo
7. Other activities: (check if applicable)

DJ/Live BandsEntertainmentHorseshoe PitsSlot/video poker machinesSoftball DiamondsVolleyball CourtsOther sports/athletic activities - describe belowOther patron participation events (i.e. sumo wrestling, bungee, etc.) - describe below
Other sports/athletic activities - Describe
Other patron participation events (i.e. sumo wrestling, bungee, etc.) If yes, please explain:
8. Have you ever had a bankruptcy or outstanding tax liens? (i.e. property tax, sales tax, unemployment tax, etc.)

YesNo
8a. If yes, please explain:

	Yes	No
4a. Abuse and Molestation?
4b. How to recognize the signs of abuse?
4c. What to do if an individual reports someone molested him/her?

	Number
1a. Number of teams participating:
1b. Total number of games:
1c. Approximate number of participants:
1d. Approximate number of spectators:

	Yes	No
1a. On prospective employees and volunteers?
1b. On existing employees and volunteers?

	Number
1a. Approximate number of participants:
1b. Approximate number of spectators:

	Name	Position	Qualifications/Experience/Certification
1
2
3