• Stadium Insurance Questionnaire

  • Applicant is:
  • How did you hear about us?
  • Please complete table:
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  • 6. Are fireworks used? (If yes, separate coverage required as this is specifically excluded.)
  • 7. Is applicant responsible for:
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  • 7d. Is applicant responsible for security?
  • 7e. Is applicant responsible for maintenance?
  • 7f. Is applicant responsible for first aid?
  • 8. List all other amusement devices along with any receipts (batting cages, bounce houses, speed pitch, etc.)
    Rows

  • 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:
    Rows
  • 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:
    Rows

  • OPTIONAL PROPERTY COVERAGES

  • 1. Do you need Computer Coverage?
  • 2. Do you need Outdoor Sign Coverage?

  • COMMERCIAL CRIME

  • 1. Do you desire coverage for Crime (Employee Dishonesty, Money, Forgery)?

  • 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.)
    Rows
  • 2b. If yes, limits desired:
    Rows
  • 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?

  • COMMERCIAL UMBRELLA

  • 1. Do you need a Commercial Umbrella?

  • DIRECTORS AND OFFICERS LIABILITY & WORKERS' COMPENSATION INSURANCE

  • 1. Do you need Directors and Officers Liability Coverage? (If yes, please contact Kevin Morency.)
  • 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://sportsprograminsurance.com/

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