• Mini-Golf Insurance Questionnaire

  • Applicant is:

  • GENERAL INFORMATION

  • 2. Please list locations and buildings at each location (List additional locations on separate page)

  • MINIATURE GOLF OPERATIONS

  • Rows
  • 3. Do fountains and waterfalls have ground fault interrupters in place?
  • 4. Is appropriate safety warning and rule/regulation signs posted at club rental counter and/or hole #1?
  • 5. Do you sell or rent any equipment?

  • OPERATIONS

  • 1. Do you require participants/members (or parents of minors) to sign an injury waiver? (Please provide a copy.)
  • 2. Do you rent your location for indoor or outdoor special events?
  • 3. Do you occupy 100% of the entire building?
  • 5. Is any of the property to be insured seasonally occupied?
  • 7. Do you ever hire sub-contractors/independent contractors that carry their own insurance?
  • 7b. If yes, are certificates of insurance provided?
  • 7c. Do you require contractors to name you as additional insured on their policy?
  • 8. Do you have cooking facilities?
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  • 8b. If yes, are all cooking surfaces covered by an UL300 Extinguishing system?
  • 8bi. Hoods/ducts cleaned by contractor?
  • 8bii. How often?
  • 8c. If yes, is there a 40 BC fire extinguisher in the kitchen?
  • 8d. Are food operations handled by?
  • 8di. If subcontracted, do you require a Certificate of Insurance?
  • 10. Do you have a first aid kit?

  • SEXUAL ABUSE -  (If located in Illinois, this section MUST be completed. If located in other states, complete only if you desire coverage.)

  • Rows
  • 2. Does the applicant verify employment/volunteer-related references?
  • 3. Does the applicant conduct personal interviews?
  • Rows
  • 5. Does applicant have supervision plan to monitor staff in day-to-day relationships with clients/children?
  • 6. Does the applicant have knowledge of any incident which could give rise to, or result in, an allegation of sexual abuse?
  • 7. Has there ever been an allegation of sexual abuse made against the insured?

  • PROPERTY INSURANCE

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

  • OPTIONAL PROPERTY COVERAGES

  • 1. Do you need Computer Coverage?
  • 2. Do you need Outdoor Sign Coverage?

  • COMMERCIAL CRIME

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

  • 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 UMBRELLA

  • 1. Do you need a Commercial Umbrella?

  • WORKERS' COMPENSATION INSURANCE

  • 1. Do you need Workers Compensation? (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://familyfuninsurance.com/miniature-golf-insurance/ 

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