*Please visit www.allrisks.com/submit-a-risk or contact your current All Risks, Ltd. producer to submit applications.
Bowling Center Supplemental Application
SUBMISSION REQUIREMENTS
ACCOUNT INFORMATION
Annual Gross Revenues: PAST 12 MONTHS NEXT 12 MONTHS
* *No off site liquor service permitted
TOTAL GROSS REVENUES: UNDERWRITING INFORMATION BOWLING ACTIVITIES:
(Flammable means the flash point is less than 80 degrees)
Bowling Center Supplemental Application - 02.17 Page 1 of 7 BUILDING INFORMATION
*NOTE: If building is over 20 years, must have been completely gutted to be eligible.
If bowstring truss is frame, building is not eligible.
OPERATIONS
Bowling Center Supplemental Application - 02.17 Page 2 of 7 Coin Operated Amusements Annual Receipts: $
Bumper Boats Annual Receipts: $
Bumper Cars Annual Receipts: $
Batting cages – WAIVER AND RELEASE REQUIRED Annual Receipts: $
Coin Operated rides Annual Receipts: $
Go-karts – Waiver and Release Required if over 21 mph Annual Receipts: $
Inflatables / Bounce and Play Annual Receipts: $
Bowling Center Supplemental Application - 02.17 Page 3 of 7 Miniature Golf Annual Receipts: $
Driving Ranges Annual Receipts: $
Paintball – Laser Tag WAIVER AND RELEASE REQUIRED Annual Receipts: $
Rock Climbing Wall - Waiver and Release Required if over 5’ Annual Receipts: $
Bowling Center Supplemental Application - 02.17 Page 4 of 7 Miscellaneous Activities: Number of Participants Annual Receipts
RESTAURANT / SNACK BAR EXPOSURE
LIQUOR LIABILITY
Bowling Center Supplemental Application - 02.17 Page 5 of 7 Bowling Center Supplemental Application - 02.17 Page 6 of 7 FRAUD NOTICE STATEMENTS
(NOT APPLICABLE IN AL, AR, AZ, CO, DC, FL, KS, LA, ME, MD, MN, NM, OK, RI, TN, VA, VT, WA AND WV). APPLICABLE IN AL, AR, AZ, DC, LA, MD, NM, RI AND WV:
APPLICABLE IN COLORADO:
APPLICABLE IN FLORIDA AND OKLAHOMA:
APPLICABLE IN KANSAS:
APPLICABLE IN MAINE, TENNESSEE, VIRGINIA AND WASHINGTON:
The Undersigned states that he/she is an authorized representative of the Applicant and declares to the best of his/her knowledge and belief and after reasonable inquiry, that the statements set forth in this Application (and any attachments submitted with this Application) are true and complete and may be relied upon by Company * in quoting and issuing the policy. If any of the information in this Application changes prior to the effective date of the policy, the Applicant will notify the Company of such changes and the Company may modify or withdraw the quote or binder. The signing of this Application does not bind the Company to offer, or the Applicant to purchase the policy.
Bowling Center Supplemental Application - 02.17 Page 7 of 7