Mechanical Bull Supplemental Application

1

Email

example@example.com

2

Employed Operators Full-Time

3

Employed Operators Part-Time

4

Annual Payroll: $

5

Names of all operators:

6

If independent contractors are ever used to operate, estimated annual costs of sub labor = $

7

Number of Bulls owned:

8

Operation of Bull(s) is :

9

Fixed Site only?

Yes

No

10

If yes, provide complete address

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Mobile?

Yes

No

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If yes, list ALL states where operations are anticipated:

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Physical Description of Bull(s):

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Bull Manufacturer Name

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Bull Manufacturer City

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Bull Manufacturer State

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Bull Manufacturer Country

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Bull Manufacturer Serial

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Bull Manufacturer Year

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Is Bull Electric?

Yes

No

21

If Galaxy, what model?

22

Does each device have an emergency shut off?

Yes

No

23

Is each device equipped with variable speed controls?

Yes

No

24

Does the device have soft horns?

Yes

No

25

Does the device have a padded head?

Yes

No

26

Minimum Fenced Radius of 10 feet or more?

Yes

No

27

Does device have enclosed inflatable arena with a minimum 16 inch inflatable landing?

Yes

No

28

Minimum ceiling/overhead clearance of 12 feet of more? Yes

Yes

No

29

Base of unit completely covered with padding?

Yes

No

31

Other:

32

Is alcohol served by the venue where the mechanical bull is present?

Yes

No

33

Do mechanical bull operators monitor for patron alcohol use?

Yes

No

34

Month and Year of the last Inspection by certified/independent inspector?

Date

35

Do operators have test procedures provided by the manufacturer to: Determine if ride is operating within manufacturer’s prescribed limits?

Yes

No

36

Evaluate product wear?

Yes

No

37

Do operators have manufacturer’s manual describing proper operation/schedules of routine inspections required/required maintenance?

Yes

No

38

Are all ride operators at least 19 years of age?

Yes

No

39

Number of operators supervising use of the unit at any one time?

40

Are operators trained to strictly enforce all rules/regulations even if it means stopping a ride early or refusing a ride to a customer?

Yes

No

41

What is the minimum age requirement you mandate for a rider?

42

Participants are required to sign waiver of liability before participating in any rides?

Yes

No

43

No one under the age of 18 can ride without the presence of their parent or legal guardian and such parent or legal guardian are required to sign waiver of liability for that rider?

Yes

No

44

Rider is participating at their own risk, and neither ride owner not operator is responsible for accident or injury to any person arising out of the mechanical bull ride?

Yes

No

45

Individuals with pre-existing conditions such as back, neck, leg or arm injuries are not permitted to ride. However, ride operator is not responsible for determining the physical condition or ability of any rider?

Yes

No

46

Participants may request that the ride be stopped at any time?

Yes

No

47

Does operator check photo ID to verify participant is same individual and age?

Yes

No

48

Are waivers signed in the presence of the operator or other attending employee?

Yes

No

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How long are signed waivers retained?

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Where stored?

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Does operator verbally ask about pre-existing injuries and if any, refuse the ride?

Yes

No

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Are your operators instructed to require riders under the age of 18 to wear helmets?

Yes

No

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Please provide a breakdown of estimated annual receipts from the following categories (If no spate records kept, then place all revenues in the “rides” category: Rides: $

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Photo or video tape receipts: $

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Souvenirs: $

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Clothing: $

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Other (describe below):

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Do you ever allow free rides?

Yes

No

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If yes, explain under what circumstances andapproximate under per year:

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Prior General Liability Insurance Company:

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Expiration Date:

Date

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Premium:

63

Describe all claims arising out of your mechanical bull units for the past 4 years:

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SUBMISSION CHECKLIST

5 year currently valued loss runs

No Known or Reported Loss Letter if operating with no prior insurance

Copy of Rental Agreement/Waiver

Safety Rules

Pictures of signage with Hold Harmless wording

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DIAGRAM OF MECHANICAL BULL SET-UPProvide a diagram of the operational area to include placement of bull, area of padding, location of fencing or other barriers, distances to spectator area, wall or any other obstructions.

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66

Type a question