Haunted House Insurance Questionnaire

Mailing Address - continued

GENERAL INFORMATION - Please complete all questions in this section.

Rows	Date of Occurrence	Description of Claim	Amount Paid	Status: Open or Closed
Claim 1
Claim 2
Claim 3

3. List locations of haunted houses if different than mailing address above

PLEASE ANSWER THE FOLLOWING QUESTIONS

Rows	Yes	No
2. If outdoors, is the area fenced?
3. Are any candles used?
4. Is there any human contact?
5. Is there any use of live animals?
6. Are there any moving floors, walls or steps?
7. Are there any slides?
8. Are bleachers or platforms used?
9. Are smoke effects used?
10. Are extension cords used?
11. Is the haunted house inspected by the fire department prior to use?
12. Are there age restrictions/limits?
13. Is first aid available?

Rows	Enter info below
15. Maximum number of individuals in house at one time:
16. Number of days open:
17. Hours of operations:
18. Anticipated number of people to go through the haunted house:
19. Estimated gross receipts:
20. Price of admission:

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

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

COMMERCIAL AUTOMOBILE INSURANCE

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

Rows	Amount ($)
Limit of Liability
Comprehensive Deductible
Collision Deductible

UMBRELLA, COMMERCIAL CRIME, AND 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
kmorency@morencyinsurance.com

Kevin Morency, Licensed Producer
Morency & Associates Inc.
141 New Shackle Island Rd, Hendersonville, TN 37075
Fax: 615-452-6580

https://familyfuninsurance.com/haunted-house-insurance/