Confirmation

CRIME EXPOSURES



• On premises:
• Maximum daily cash: $
• Amount overnight: $
• Desired crime limit:
• Safe?
  Yes No
What manufacturer:

ADDITIONAL INTERESTS



• 1) Name:
Landlord Loss Payee Mortgagee


• Mailing address:


• City:
• State:
• Zip code:



• 2) Name:
Landlord Loss Payee Mortgagee


• Mailing address:


• City:
• State:
• Zip code:

INSURANCE INFORMATION:



Information for General Liability:


• Insurance comp. name:
• Date policy expires:
• Premium: $
• Deductible: $
• Limits:
• Premium Basis:

Information for Umbrella:



• Insurance comp. name:
• Date policy expires:
• Premium: $
• Deductible: $
• Limits:
• Premium Basis:

Information for Workers Compensation:



• Insurance comp. name:
• Date policy expires:
• Premium: $
• Deductible: $
• Limits:
• Premium Basis:

LIABILITY CLAIMS INFORMATION:



• How many claims in the last 5 years: 0 123456789
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $
Year of claims: None 2013 2012 2011 2010 2009
Number of claims:
Amount paid: $




POLICY RECOMMENDATIONS

(Please check any you are interested in)


• General Liability
• Accident Medical
• Earthquake
• Inland Marine
• Worker's Compensation
• Commercial Auto
• EPLI
• Flood
• Hired & Non-Owned Auto
• Umbrella
• Abuse/Molestation
• Cyber Liability




WARRANTY

It is hereby understood and agreed that if insurance is issued by virtue of completing this application, the Insurance is only issued on the reliance on the applicant’s warranty of answers to the questions above. If, at the time a certificate/policy is issued and ANY OF THE ABOVE WARRANTIES IS IN ANY RESPECT INCORRECT, INCLUDING CLAIMS OR GROSS RECEIPTS, THE COVERAGE AFFORDED UNDER THE CERTIFICATE/POLICY shall, without notice to the applicant, immediately and automatically cease, & the certificate/policy shall BECOME NULL AND VOID.


• Person Applying:
• Date Submitted:



• Terms of Agreement:
     By checking this box, I hereby agree to the terms of filling out this application, and I also announce that I have filled this application out with the best of my knowledge.

  By signing below, I hereby agree to the terms of filling out this application, and I also announce that I have filled this application out with the best of my knowledge.

  
  
  

  IP: 18.223.172.252
Do you have another location you would like to include in this application?
Yes No


Please make sure that you have completed everything to the best of your knowledge before going to the next page.

Need Help?
Call 864-688-0121
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Once you get to the end of the current page click the next button to submit the page and you will receive an email with a link to complete the rest of your application at your convenience.

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FAQ's

Are there really 13 pages in this application?

Yes, because every Family Fun Center is unique we need to ask the questions that will encompass the needs of all Family Fun Centers. Many of the questions on various pages may not apply to your FEC, so you will most likely not need to fill out every page of the application.

Do I need to answer all of these Questions?

You will only need to answer the questions that apply to your Family Fun Center. You should try to complete all of the questions that do apply to your FEC. If you provide us with a complete application the processing time for the application will be less as we do not have to request additional information from you.