Stadium Insurance Questionnaire

Stadium Insurance Questionnaire
Applicant's Name:*
Address:*
Mailing Address
Address (cont):*
Mailing Address - continued
Contact:*
Email*
Telephone:*
Website
Fax:
Applicant is:

IndividualPartnershipCorporationOther (specify)Other
Current Carrier:
Expiration Date:
Limits: ($)
Premium: ($)
Deductible: ($)
GL Occurrence Limits desired:

Please complete table:

Rows	Enter numbers below
1. Estimated annual attendance:
2. Gross annual sales for all operations:
3. Annual receipts from ticket sales:
4. Maximum capacity:
5. Average event attendance:

6. Are fireworks used? (If yes, separate coverage required as this is specifically excluded.)

YesNo

7. Is applicant responsible for:

Rows	Yes	No	If yes, annual receipts ($)
a. Parking?
b. Concessions (excluding alcohol)?
c. Alcohol sales?

7d. Is applicant responsible for security?

YesNo
7di. If no, who is responsible?
7e. Is applicant responsible for maintenance?

YesNo
7ei. If no, who is responsible?
7f. Is applicant responsible for first aid?

YesNo
7fi. If no, who is responsible?

8. List all other amusement devices along with any receipts (batting cages, bounce houses, speed pitch, etc.)

Rows	Description	Receipts ($)
Item 1
Item 2
Item 3
Item 4

9. Describe the use of the stadium or grounds for other purposes (public speakers, craft sales, festivals, concerts, little league tournaments, company picnic and ball game, etc.):