Bicycle Shop Insurance Questionnaire

Mailing Address - continued

Bicycle, E-bike, Segway, Cross Country Ski - Sales/Service/Rental | Rides | Tours | Special Events

DEALER INFORMATION

	Retail Sales	Service and Repair	Used Sales	Consignment Sales*	Used Parts Sales*	Tours	Rides
a. Bicycle
b. E-Bike
c. Segway
d. Watercraft*
e. Cross-country ski
f. Fitness Equipment
g. Clothing
h. Shoes
i. Other - Describe below
Total Gross Sales

	Residential	Commercial
Equipment Sales

BICYCLE INFORMATION

BICYCLE AND EQUIPMENT RENTAL OPERATIONS

BicycleE-BikeSegwayOther

	Yes	No
a. Is the outdoor area on your premises for test riding bicycles free of potholes and cracks?
b. Are parents required to supervise younger children while they test ride?
c. Do you always require helmets for test rides of bicycles, E-bikes and Segways?
d. Do you require protective shoes (i.e. sneakers or athletic footwear) for bicycle, E-bike, and Segway testers?
e. Do you require the test rider or parent of test rider sign a hold harmless agreement? (Copy please.)

	Rental Receipts	Required Age to Rent
a. Bicycle
b. E-bike
c. Segway
d. Cross Country Skis
e. Skates
f. Skateboards

	Yes	No
a. Do you always require helmets and protective shoes (i.e. sneakers or athletic footwear) for bicycle, E-bike, Segway, skate, and skateboard rentals?
b. Do you have the renter or parent sign a hold harmless agreement for bicycle, E-bike, Segway, cross country ski, skate, and skateboard rentals?

CONCESSIONS (FOOD & BEVERAGES)

	Enter Number Below
Concession Receipts ($)
Number of Stands
Square Footage

Full-ServeSnack BarLessor's Risk

InsuredSubcontractor

	Enter Number Below
Ranges
Ovens
Deep Fryers
Grills
Broilers
Griddles

MonthlyQuarterlySemi-AnnuallyAnnually

Note: If Liquor Liability coverage is desired, please contact Kevin Morency for a quote. (Liquor Liability will only be available if we provide the General Liability for your family entertainment center operation.)

CANOE, KAYAK, PADDLE BOAT, TUBE RENTAL

SPECIAL EVENT, ROAD TRIP/RACE INFORMATION

OPTIONAL PROPERTY COVERAGES

	Building Age	Building Construction	Building Limit ($)	Content Limit ($)
Building 1
Building 2
Building 3

Replacement CostActual CostTotal Value ($)

	Year	Make	Model	Value to Insure For ($)
Item 1
Item 2
Item 3

COMMERCIAL AUTOMOBILE INSURANCE

	Vehicle Make	Vehicle Model	Cost New ($)	Year
Vehicle 1
Vehicle 2
Vehicle 3

	Amount ($)
Limit of Liability
Comprehensive Deductible
Collision Deductible

WORKERS' COMPENSATION INSURANCE

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://insurancebikeshop.com/