• Bicycle Shop Insurance Questionnaire

  • Applicant is:
  • How did you hear about us?
  • Bicycle, E-bike, Segway, Cross Country Ski - Sales/Service/Rental | Rides | Tours | Special Events

  • DEALER INFORMATION

  • 1. Are any operations conducted outside the United States. (If yes, not eligible for program.)
  • 3. Is your business operational year round?
  • 5. Do you have specialized training from manufacturers or others?
  • 6. Do you offer delivery?
  • 7. Please provide receipts ($) for the following: (Non-motorized watercraft only - canoe, kayak, paddleboat, or similar)
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  • 8. What percentage of equipment sales is:
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  • BICYCLE INFORMATION

  • 1. Do you use a bike assembly checklist?
  • 2. Is a torque wrench available and in use?
  • 3. Do you offer bicycle repairs away from premises?
  • BICYCLE AND EQUIPMENT RENTAL OPERATIONS

  • 1. What equipment do you allow test rides?
  • 2. Bicycle, E-Bike, and Segway Testing Area
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  • 3. Do you rent bicycles, E-bikes, Segways, Cross Country Skis, Skates or Skateboards?
  • 4. Please provide the following information (Provide copy of each type of rental agreement.)
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  • 6. Please answer the following. (Provide copy of each type of hold harmless agreement.)
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  • 6. When the equipment (bicycle, E-bike, Segway, cross country skis, skates, skateboards) comes back from rental, is each item checked by an employee and updated in a written maintenance log before it is rented again?
  • 8. Do you guide rock climbing?
  • CONCESSIONS (FOOD & BEVERAGES)

  • 1. Do you offer food and beverage concessions?
  • 1a. If yes, complete table below:
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  • 2. What is restaurant exposure?
  • 3. Do you offer food delivery?
  • 4. Are food operations handled by?
  • 4a. If subcontracted, is certificate collected?
  • 5. Is there cooking on premises?
  • 5a. If yes, indicate which of the following apply and the number of each:
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  • 6. Is there a 40 BC fire extinguisher in the kitchen?
  • 7. Are all cooking surfaces covered by an UL300 Extinguishing system?
  • 8. Are hoods/ducts cleaned by contractor?
  • 8a. How often?
  • 9. Do you serve alcohol at your operation?
  • 9d. Will you allow others to serve alcohol at this event? (If yes, Certificates of Insurance are required.)
  • 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

  • 1. Do you offer canoe, kayak, or tube rental? (non-motorized watercraft only)
  • b. Is the “State Recreation Law” posted? (If yes, please attach a photo.)
  • c. Does the rental agreement have a “Hold Harmless” clause in it?
  • d. Is rental agreement with waiver of liability signed by client? (If yes, please attach copy.)
  • h. Do you follow a comprehensive maintenance schedule for the vehicle and watercraft (tubes)?
  • i. Are applicable governmental regulations followed?
  • j. Are life jackets required?
  • n. Any sales of alcohol?
  • SPECIAL EVENT, ROAD TRIP/RACE INFORMATION

  • 1. Do you conduct special events?
  • 2. Do you have employee or other events on your premise?
  • 2a. If yes, is alcohol served?
  • 3. Are road trips or bicycle races ever hosted by you?
  • COMMERCIAL CRIME

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

  • 1. Do you need Building and/or Content Coverage? (If yes, complete chart below.)
  • 1a. If yes, please provide the information below (or provide information on a separate sheet).
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  • 2. Do you need Computer Coverage?
  • 3. Do you need Outdoor Sign Coverage?
  • 4. Do you need Equipment Coverage?
  • 4a. If yes, total value to insure for?
  • 4b. If yes, please complete equipment schedule below or provide a separate equipment schedule with the following information:
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  • 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?
  • 2a. (If yes, complete chart below or provide a separate vehicle/fleet schedule with following info.)
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  • 2b. If yes, limits desired:
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  • 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.)
  • Privacy Policy and Terms & Conditions*
  • 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
    kmorency@morencyinsurance.com 

    Kevin Morency, Licensed Producer
    Morency & Associates Inc.
    141 New Shackle Island Rd, Hendersonville, TN 37075

    Fax: 615-452-6580

    https://insurancebikeshop.com/

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