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Company Info
Premises
Operations
Rentals
Abuse
Liquor
Auto
Property
Confirmation
Section 2B: Cooking Facilities
Do you have any cooking facilities?
Yes
No
Does applicant have an automatic extinguishing system over deep fat fryers, grills & stoves?
Yes
No
How often are hood/ducts cleaned?
Yes
No
By whom:
Insured
Contractor
If by sub-contractor, how often are they serviced?
Date last serviced:
What is the restaurant exposure?
Full Serve
Snack Bar
Lessor’s Risk
Square Footage
Indicate which of the following apply and the number of each:
Ranges
Grills
Ovens
Broilers
Deep Fryers
Griddles
Are portable fire extinguishers provided in the kitchen?
Yes
No
Section 2C: Rides / Attractions
Does the facility have copies of and adhere to ASTM (American Society for Testing and Materials) standards for all applicable rides and devices?
Yes
No
Are documented pre-opening inspections and regularly scheduled preventative maintenance inspections performed per ASTM – F853 standards as well as the ride manufacturers’ specifications?
Yes
No
Does / has the applicant ever manufactured or retro-fitted any amusements / attractions?
Yes
No
If yes, please provide a list of all such attractions and changes made:
Are periodic inspections required by state inspectors?
Yes
No
Are all required state, county, and/or local licenses or permits current?
Yes
No
Permit Expiration Date:
Date of latest inspection:
Has insured ever received a citation for violation of licensing/permit requirements?
Yes
No
Are rides inspected daily?
Yes
No
Is inspection log maintained?
Yes
No
Are maintenance manuals for all rides kept on premises?
Yes
No
Is there a qualified maintenance staff on site?
Yes
No
Is there an on-site maintenance shop?
Yes
No
Is there adequate maintenance equipment on site?
Yes
No
Are there rides where the operator controls the speed?
Yes
No
If yes, please provide a list and operator training required:
Is fencing around the entire perimeter of each ride to restrict unauthorized access?
Yes
No
Are safety, warning, and instructional signs in place at each ride/attraction?
Yes
No
Is playground equipment present?
Yes
No
Please Provide List:
Are buses or trams used on the premises?
Yes
No
Do you have a written loading/unloading procedure?
Yes
No
What are the qualifications required of the driver?
Yes
No
Do you provide transportation for patrons off premises, i.e. to hotels or motels?
Yes
No
Do all ride/attraction attendants receive documented training on the specific standard operating procedures and emergency procedures for the ride(s) and/or attractions(s) they will work on?
Yes
No
If yes, please provide copy of any written material.
Section 3: Operations Part 1 of 4
Do you operate any of the following? (Please select all that you operate)
Arcades
Batting Cages
Billiards
Bowling
Bumper Boats
Bumper Cars
If none of these apply please click NEXT to continue to the next page.
Arcades
Annual sales:
$
How many do you have?
No. of attendants:
Equipment is:
Owned
leased
Are machines properly grounded?
Yes
No
Is there an on-site maintenance shop?
Yes
No
Is there adequate maintenance equipment on site?
Yes
No
Who provides service/maintenance on machines?
Non-slip, non conductive floor covering?
Yes
No
Types of games:
Are there any coin-operated rides?
Yes
No
Any interactive games or ride simulators?
Yes
No
If yes, describe:
Batting Cages
Annual sales:
$
How many:
Manufacturer:
# of Attendants:
Min. age requirement:
Mfg. age/speed recs posted?
Clearly marked for right or left handed hitters:
Yes
No
Are home plates clearly marked:
Yes
No
Machine velocity checked or calibrated:
Yes
No
Who checks & calibrates?
Are records kept?
Yes
No
How long are records kept?
Are pitching machine settings able to be altered by hitters?
Yes
No
Are pitching machines properly calibrated as per manufacturers’ specifications?
Yes
No
Helmet or other safety equipment required to be used by participants?
Yes
No
Light or similar indicator when last ball has been pitched?
Yes
No
Are batting cage doors self-closing and self-latching?
Yes
No
Are only manufacturer approved balls utilized?
Yes
No
Is safety, warning, and instructional signage posted on every batting cage entrance?
Yes
No
Is there only one participant per batting cage permitted at one time?
Yes
No
Are cages completely enclosed and free from holes or breaks in the netting or chain link?
Yes
No
Do participants stand on a non-skid surface?
Yes
No
Is there only one participant per batting cage permitted at one time?
Yes
No
Is there at least one attendant present during operation?
Yes
No
Reduced Injury Factor (RIF) baseballs used?
Yes
No
Please click on the browse button to upload your waiver.
Billiards
Annual sales:
$
Number of billiard and/or pool tables?
Are tournaments permitted?
Yes
No
Are there attendants in the billiard and pool playing area?
Yes
No
Do participants stand on a non-slip surface?
Yes
No
Bowling
Annual sales:
$
Number of lanes:
Lane Finish:
Lacquer
Polyurethane
Oil
Water Based
Urethane
Any flammable liquids stored on premises?
Yes
No
If yes, list products & amounts?
Are all flammable liquids stored in UL approved containers?
Yes
No
Do you contract the lane refinishing?
Yes
No
How many total years of management experience do you have:
Total years at this location:
Hours of Operation:
Does your bowling center have automatic scoring equipment?
Yes
No
Do employees repair and/or maintain the automatic bowling equipment?
Yes
No
If no, who services?
Are food and drinks restricted from bowling area?
Yes
No
Are ball racks secured or anchored to the floor?
Yes
No
Percent of business from:
League Activity
Open Play
Do you sponsor any professional tournaments?
Yes
No
Do you have a Pro Shop on premises?
Yes
No
Is your Pro an:
Employee
Independent Contractor
If an Independent Contractor, do they provide proof of insurance naming you as an Additional Insured?
Employee
Independent Contractor
Bumper Boats
Annual sales:
$
How many do you have?
Manufacturer:
No. of operators:
Height of fence (ft):
Max. engine horsepower:
Age/Height limit = 10 years and 48 inches?
Yes
No
Depth of water 4 ft. or less?
Yes
No
Are attendants certified in CPR?
Yes
No
Are attendants certified in medical First Aid?
Yes
No
Is water rescue equipment (throw rings, shepherd hooks) present?
Yes
No
Does gas storage meet NFPA/Local fire code?
Yes
No
Are more than 100 gallons of gasoline stored on the premises?
Yes
No
Where are the boats refueled?
Are the propellers on the motor protected?
Yes
No
If yes how?
Bumper Cars
Annual sales:
$
How many do you have?
Manufacturer:
How many attendants?
Min. height required (in.):
Are rider instructions posted and enforced?
Yes
No
Are spectators restricted from floor area while bumper cars are in motion?
Yes
No
Bumper cars inspected daily?
Yes
No
Type of seat belt:
Cars equipped with dash and headrest pads?
Yes
No
Wheel pads on steering wheels?
Yes
No
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