• Inflatable Insurance Questionnaire

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

  • (Jumping Pillows, Jumping Pads, Bouncy Houses, Bouncy Slides, Bouncy Castles, Moonwalks)

  • GENERAL INFORMATION

  • INFLATABLES (Jumping Pillows, Bouncy Houses/Slides, Etc.) 

  • 1a. Please complete table:
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  • 2. Are you a member of the IIP & GA (International Inflatable Products and Games Association)?
  • 3. Please complete chart below or provide a separate schedule with the following information:
    Rows
  • 4. Other items rented: (e.g. Tents, Chairs, snow cone machines, etc.) Include gross sales.
    Rows
  • 5. Other operations: (e.g. Concessions, games, etc.) Include gross sales for each:
    Rows
  • 6. (NOT APPLICABLE IN MO) Has any policy or coverage ever been declined, cancelled or non-renewed?
  • 7. Has the proposed coverage been purchased before?
  • 7a. If yes, please fill in the following:
    Rows
  • 9. Renting Inflatables
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  • 10. Equipment Inspection
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  • 11. If required by your state, do you have a permit/license? (If yes, please provide copy.)

  • CONCESSIONS (Food & Beverages)

  • 1. Do you offer food and beverage concessions?
  • 1a. If yes, complete table below:
    Rows
  • 2. What is restaurant exposure?
  • 3. Is fast food delivery service available?
  • 4. Are food operations handled by?
  • 4a. If subcontracted, is certificate collected?
  • 5. Is there cooking on premises?
  • 5a. If yes, indicate which of the following apply and the number of each:
    Rows
  • 6. Is there a 40 BC fire extinguisher in the kitchen?
  • 7. Are all cooking surfaces covered by an UL300 Extinguishing system?
  • 8. Are hoods/ducts cleaned by contractor?
  • 8a. How often?
  • 9. Do you serve alcohol at your operation?
  • 9c. Will you allow others to serve alcohol at this event? (If yes, Certificates of Insurance are required.)

  • 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.)

  • 1. Does the applicant perform a criminal background investigation, including sexual abuse or child abuse-related offenses:
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  • 2. Does the applicant verify employment/volunteer-related references?
  • 3. Does the applicant conduct personal interviews?
  • 4. Does the applicant discuss the following items at staff orientation:
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  • 5. Does applicant have supervision plan to monitor staff in day-to-day relationships with clients/children?
  • 6. Does the applicant have knowledge of any incident which could give rise to, or result in, an allegation of sexual abuse?
  • 7. Has there ever been an allegation of sexual abuse made against the insured?

  • COMMERCIAL CRIME

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

  • 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

  • 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?

  • 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://bouncyinsurance.com/

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