Family Entertainment Center Online Application
Request for Quotation

Please complete the following application. Once the application is received, a quotation will be sent within one business day. As activities vary, some questions may not be applicable. Please indicate N/A where necessary. Print your completed form if you would like a copy for your records.
(*) indicate required fields

 
 
GENERAL INFORMATION
Facility Name *   Contact Person / Title*  
Person responsible for activities   FEIN/TAX ID  
Phone *   Website Address  
Fax   Email *  
Facility Address  
Address *   City *  
State *   Zip Code *  
       
Mailing Address
Check here if the mailing address is same as the facility address
Address   City  
State   Zip Code  
           
Date of Formation *
Calender
Business Type *
 
     
Number of Employees
Years of experience
Annual Gross Receipts *
     
Proposed effective date *
Calender
   
           
INSURANCE INFORMATION
 
Currently insured? *   Current Insurance Company  
           
Current premium   Has Prior Insurance ever Been Cancelled / Non-Renewed? *  
 
GENERAL LIABILITY COVERAGE LIMIT
           
Occurrence   Aggregate  
 
GENERAL QUESTIONS
Are rules posted conspicuously and enforced at all times? Yes No
Are participants required to wear safety equipment during play? Yes No
Are copies of the Waiver & Release of Liability kept on file? Yes No
Do you currently have a risk management plan? Yes No
Are the referees or coaches employees of your organization? Yes No
Are parking lots well lit and patrolled? Yes No
Are facility/playing field inspections and maintenance performed? Yes No
Is a log kept of inspections and maintenance performed? Yes No
Does the facility rent or repair sports equipment? Yes No
Is the facility locked so that patrons cannot use it when closed? Yes No
Are there construction operations on site? Yes No
Do you provide childcare on site? Yes No
Are there any water hazards or unfenced bodies of water on your premises? Yes No
Does the park/facility conduct fireworks display? Yes No
 
INDOOR FUN FACILITY
 
Number of Rooms Max Occupancy Total Square footage
Do you have?    
Day Care
Yes No
Camps
Yes No
After School Program
Yes No
     
Any Drop offs?
Yes No
Must parents stay with child?
Yes No
Is an attendant always there?
Yes No
     
Customers bring alcohol
Yes No
Alcohol served
Yes No
Liquor License
Yes No
     
Is it in a strip mall or other building?
Yes No
If yes, other occupancies
Yes No
 
Hours of Operation    
Monday - Friday
-
Saturday
-
Sunday
-
     
EQUIPMENT / PROPERTY: PART A
 
100% Replacement value of building (IF OWNED)
Building Year
Number of stories?
     
Square footage of part of building occupied
Square footage of entire building
 
 
EQUIPMENT / PROPERTY: PART B
Building Improvments / Updates
Wiring Year
Roofing Year
Plumbing Year

       
Fire Sprinklers
Yes No
Extinguishers
Yes No
Alarm
Yes No
Burglar alarm company and type
       
Any restaurants or apartments located next door to or inside your building?
Yes No
   
     
UNDERWRITING INFORMATION


Check all application activities and provide requested information.

Attendant Operated Mechanical Rides
Batting Cages
Bowling
Bumper Cars
Bumper Boats
Coin Operated Equipment and Mechanical Rides
Driving Range
Food Operations / Concession Stands
Inflatable Rentals (With Operators)
Inflatable Rentals (Without Operators)
Go Kart Rides
Laser Tag
Miniature Golf
Roller Skating Rinks
Other Activities
Additional information of the business operations/activities:
 
Document Upload


Are participants required to sign a Waiver & Release of Liability / Rental Agreement? attach a copy.


Are written emergency procedures in place (Emergency Evacuation Plan)? attach a copy


Please Include Loss Run


Copy of Posted Rules


Other Documents


How did you hear about us?


I have read and agree to the terms above.

 
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