HOTEL APPLICATION 3/22 EDITION
Full Legal Named Insured
MAILING Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
First Name
Last Name
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
SELECT ALL THAT APPLY
Aluminum Wiring
Occupancy below 60%
Armed Security (third party or employees)
Hourly Rentals
Marinas / Boat Slips / Docks
Saddle Animal rental
Policy been cancelled or non-renewed
Named Insured is in Bankruptcy
Years in Business as current Named Insured (entity formation date)
Years in Hospitality Business
If there any Third Party Contracts in place, please list describe
Do you lease Commercial Space
Yes
No
Commercial Space leased Tenant Description & Square Footage
Tenant Description
Square Footage
Rental Spaces for Mobile Homes & Campers
Yes
No
If you offer rental spaces for Mobile Homes & Campers, how many of each?
Mobile Homes
Campers
Any time Share Units
Yes
No
If yes, how many units?
SELECT ALL THAT APPLY - Amenity Rentals
Beach Gear
Paddle Boards
Canoes
Powered Watercraft
Day Trips / Excursions
Are you planning any structural renovations?
Yes
No
SELECT ALL THAT APPLY
Is there a bar, tavern or lounge selling over 70% receipts Alcohol
Beachfront
Boat docks, ramps, slips
Convenience Store
Fitness Center
Hot Tub (not guest rooms)
Lakes
Playground
Restaurant (complete separate application)
Sauna / Steam Room
Swimming Pools (if no pool on premises, go to the next question) - Select all that apply
Pool operated on your facility
Anti-Vortex Drain Cover (Virginia Graeme Baker Pool & Spa Safety Act)
Depths Marked
Rules Posted
Competitions
Diving Team
Swimming Instruction
Completely fenced with self latching gate
Life guards on duty
CPR Training for employees
Life Guards contracted out to third party
Slides / Diving Boards
Fire Extinguishers adequately placed / current service tags
Security Controls - Select all that apply
CCTV public areas
Peep Holes in Guest Rooms
3rd Party off duty Peace Officers
Additional Insured Certificates on file
Smoke Detectors
If yes, battery
or Hard Wired
Gross Hotel Sales (no restaurant sales) projected for next twelve months
Gross Food and Beverage Sales (including alcohol)
Gross Alcohol Sales
Explain all work completed by subcontractors
Select all that apply
Named Insured is Additional Insured on Subcontractors Policy
Certificates of Insurance on file for all vendors
Number of Full Time / Part Time Employees
FULL TIME
PART TIME
Coverage Options - General Liability - Select all you would like proposed
Employee Benefits Liability
Employment Practices Liability
High Limits Liability
Identity Theft
Increase Medical Expense to $10,000
Add Stop Gap Liability
Coverage Options - Property - Select all you would like proposed
Ordinance or Law / Increased Cost of Construction
Equipment Breakdown
Property Coverage Extensions
Outdoor signs
Water Back Up - Sump Overflow
Submit
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