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Company Info
Premises
Operations
Rentals
Abuse
Liquor
Auto
Property
Confirmation
Section 6: SUBMISSION REQUIREMENTS
In order to process your application we need you to attach the following documents:
Completed Application with all Questions Answered
Loss Runs (5 years)
No loss letter if operating with no insurance
Copy of rental agreement or waiver
Picture of signage with hold harmless wording (Pay for Play Only)
Safety Rules
WARRANTY
(Applies to all parts of this application and attachments submitted)
It is hereby understood and agreed that if insurance is issued by virtue of completing this application and any applicable supplemental applications, the Insurance is only issued on the reliance on the applicant’s warranty of answers to the questions above and on any such supplemental applications. 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. Warranties will survive a certificate/policy if issued.
Person Applying:
Title:
Date Submitted:
Draw your signature
Draw It
Clear
I accept the terms of this agreement.