Cossio Insurance Agency Family Entertainment Centers
Activity 1
NOTE: Remember not to hit your back button or your refresh button so that you do not
accidentally erase or wipe out any type of information that you have typed in.
Please click on an operation type from the list. Then answer the questions inside each operations. After
completely answering the questions, you may click on a new type of operation to begin completing new sets of questions.
Attendant Operated Rides
Annual sales:
$
How many different types of attendant operated rides do you have:
Name:
Manufacturer:
Receipts:
Describe
Attraction ht:
Age/ht req:
Name:
Manufacturer:
Receipts:
Describe
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Name:
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Batting Cages
Annual sales:
$
How many:
$
Manufacturer:
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 pitching machine settings able to be altered by hitters?
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 records kept?
Yes
No
How long are records kept?
Reduced Injury Factor (RIF) baseballs used?
Yes
No
Cages Enclosed?
Yes
No
Non-Skid Surface?
Yes
No
Please click on the browse button to upload your waiver.
Bowling
Annual sales:
$
Number of lanes:
Lane Construction:
Wood
Synthetic
Hours of Operation:
Do you contract lane refinishing?
Yes
No
Are ball racks secured or anchored to the floor?
Yes
No
Do you have special events, such as Tournaments, Big Games etc?
Yes
No
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 sponsor any professional tournaments?
Yes
No
If yes, list events and sponsors:
If yes, are certificates of insurance obtained from the sponsoring organization?
Yes
No
Lane Finish:
Lacquer
Polyurethane
Urethane
Water Based
Bumper Boats
Annual sales:
$
How many do you have?
Manufacturer:
No. of operators:
Depth of water 4 ft. or less?
Yes
No
Age/Height limit = 10 years and 48 inches?
Yes
No
Height of fence (ft):
Max. engine horsepower:
Bumper Cars
Annual sales:
$
How many do you have?
Manufacturer:
Min. height required (in.):
How many attendants?
Type of seat belt:
Cars equipped with dash and headrest pads?
Yes
No
Wheel pads on steering wheels?
Yes
No
Coin Operated Amusements
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
Do you provide your own maintenance on equipment?
Yes
No
Is there adequate maintenance equipment on site?
Yes
No
Non-slip, non conductive floor covering?
Yes
No
Please make sure that you have completed everything to the best of your knowledge before going to the next page.