Cossio Insurance Agency FEC Renewal
General Information
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GENERAL LIABILITY
location(s) covered:
Fill in below, total annual receipts for each attraction at above facility(facilities)
TYPE OF OPERATIONS
LAST YEAR'S ANNUAL RECEIPTS
ESTIMATED ANNUAL RECEIPTS
Coin Operated Amusement Equipment:
$
$
Bumper Boats:
$
$
Bumper Cars:
$
$
Batting/Pitching Cages:
$
$
Coin Operated Rides:
$
$
Go Karts:
$
$
Attendant Operated Rides:
$
$
Lazer Tag:
$
$
Bounce Play/Soft Play:
$
$
Miniature Golf:
$
$
Driving Ranges:
$
$
Gift/Pro-Shops:
$
$
Food Operations:
Concessions?
Yes
No
$
$
Alcoholic beverages:
$
$
Room Rentals:
$
$
Climbing Wall:
$
$
Bowling:
$
$
Paintball:
$
$
Ice Skating:
$
$
Roller Skating:
$
$
Water slides:
$
$
Euro Bungee:
$
$
Trampolines:
$
$
Rope Ladders:
$
$
Mechanical Bull:
$
$
Shuffleboard:
$
$
Simulators:
$
$
Volleyball/Basketball:
$
$
Tennis Courts:
$
$
Billiard/Pool Table:
$
$
Off-Site Inflatable Rentals:
$
$
Other:
$
$
Other:
$
$
Other:
$
$
Other:
$
$
Other:
$
$
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