• Firearms Instructor Insurance Questionnaire

  • Applicant is:
  • How did you hear about us?

  • GENERAL INFORMATION

  • 3. Do you provide live fire instruction at a gun range?
  • 3a. If yes, do you own or rent the gun range?
  • 4. Do you offer any tactical, military, law enforcement, survivalist, or SWAT/Crisis Team training? *
  • 5. Are participants required to sign any releases of waivers? (If yes, please attach a copy of the waiver.)
  • 6. Are eye and ear protection required?
  • 7. If students provide their own weapons, does the instructor check each weapon before firing?
  • 9. Do you offer services through independent contractors?
  • 9b. If yes, are certificates of insurance provided?
  • 9c. Do subcontractors name you as additional insured on their policy?

  • PROPERTY INSURANCE

  • 1. Do you need Building and/or Content Coverage?
  • 1a. If yes, please complete chart below or provide a separate property schedule with the following information:
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  • 2. Do you need Equipment Coverage?
  • 2a. If yes, total value to insure for?
  • 2b. 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?

  • UMBRELLA AND WORKERS' COMPENSATION INSURANCE

  • 1. Do you need a Commercial Umbrella?
  • 2. 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://certifiedfirearmsinstructorinsurance.com/

     

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