Paintball Insurance Questionnaire

Mailing Address - continued

GENERAL INFORMATION

	Annual Gross Sales ($)
a. Field Play Activities (rentals, fills, paintballs sold, field fees)
b. Pro Shop Sales
c. Food Sales
d. Customer equipment repair
e. Other: (Describe below)

EQUIPMENT SAFETY

	Feet Per Second (FPS)
Indoor
Outdoor

CONCESSIONS (Food & Beverages)

	Enter number below
Concession Receipts ($)
Number of Stands
Square Footage

Full-ServeSnack BarLessor's Risk

InsuredSubcontractor

	Enter number below
Ranges
Ovens
Deep Fryers
Grills
Broilers
Griddles

MonthlyQuarterlySemi-AnnuallyAnnually

Note: If Liquor Liability coverage is desired, please contact Kevin Morency for a quote. (Liquor Liability will only be available if we provide the General Liability for your agritainment operation.)

SEXUAL ABUSE (If located in Illinois, this section MUST be completed. If located in other states, complete only if you desire coverage.)

	Yes	No
1a. On prospective employees and volunteers?
1b. On existing employees and volunteers?

	Yes	No
4a. Abuse and Molestation?
4b. How to recognize the signs of abuse?
4c. What to do if an individual reports someone molested him/her?

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

Replacement CostActual CostTotal Value ($)

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

COMMERCIAL AUTOMOBILE INSURANCE

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

	Amount ($)
Limit of Liability
Comprehensive Deductible
Collision Deductible

UMBRELLA 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
Kevin Morency | kmorency@morencyinsurance.com

Morency & Associates Inc.
1194 Long Hollow Pike, Gallatin, TN 37066
Fax: 615-452-6580

https://familyfuninsurance.com/

Paintball & Airsoft Insurance Questionnaire