Haunted House Insurance Quote Request

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What is Your Name?(Required)

First Last

What is your role in the operation?

CEO, organizer, owner, marketing, secretary...

What is the full legal name of your company/operation?(Required)

What type of organization is this?(Required)

Describe your organization's role & responsibility in event(Required)

Hosting, sponsoring, vendor at an event...

What is the mailing address of the organization?(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

E-mail(Required)

Fax

Hahaha who still uses faxes?

If the event has a website please enter it here.

Please provide a full schedule, description and purpose of event.(Required)

Is this event part of a larger function?(Required)

Like a carnival, a street fair, a festival....

Yes

If “Yes,” describe(Required)

Does your entity own the property that the event is taking place on?(Required)

Your Entity is the entity you entered at the top of this form.

Yes

Is there an admission charge?(Required)

Yes

If “Yes,” what is the cost of admission per person?(Required)

What date will the event start?(Required)

MM slash DD slash YYYY

What date will the event end?(Required)

MM slash DD slash YYYY

What date do you need coverage to start?(Required)

MM slash DD slash YYYY

What date do you need coverage to end?(Required)

MM slash DD slash YYYY

If event dates differs from desired coverage dates, explain

Opening Time (HH:MM AM/PM)(Required)

Closing Time (HH:MM AM/PM)(Required)

What is the name of the venue that the function is taking place at?(Required)

What is the full address of where the event will take place?(Required)

What type of location is this?(Required)

Check all that apply.

Private Residence

Liquor Licensed Establishment

Indoors

Outdoors

Convention Center

Stadium

Arena

Fair Grounds

Other

if "Other" please explain in detail.(Required)

ESTIMATED ATTENDANCE PER DAY(Required)

TOTAL Attendance for ALL days.(Required)

What is the maximum capacity of facility?(Required)

Average age of the attendees?(Required)

Give us your best approximation.

Is this event invite only or open to the public?(Required)

Invite

Public

What was the actual total attendance for Prior Year’s event?(Required)

How many years has the event been previously held?(Required)

Enter 0 (zero) if this is the 1st year for the event.

Does facility you are holding the event at require a contract for usage?(Required)

Yes

Liability Details

What liability limit do you need?(Required)

1000000

Other

If other than $1,000,000 please specify(Required)

Please specify which of the following will be present.

Rides, mechanical devices, rebounding devices (ie: moonbounce, trampoline)?(Required)

Yes

Petting Zoo, animal rides?(Required)

Yes

Fireworks/Pyrotechnics?(Required)

Yes

Are Vendors, Attraction Owners and Performers required to carry their own insurance?(Required)

Yes

If “Yes,” what liability limit is required?(Required)

Will concessionaires provide you with certificates evidencing products liability with your organization named as Additional Insured?(Required)

Yes

Security & Staff

Is security provided by(Required)

Check all that apply

There is no security

Independent Contractors

Your Employees

On-Duty Police

Off-Duty Police

Guard Dogs

Describe the security measures.(Required)

Who contracts security?(Required)

Facility

You , The Applicant

Number of Security Personnel to Be Present?(Required)

If security provided by Independent Contractors, are they required to carry their own insurance?(Required)

Yes

Aside from the security personnel, how many employees will YOU have?(Required)

Include all actors, ticket sales, grounds keepers, assistants, vending sales....

Do you currently have workers compensation in place for your staff members?(Required)

Yes

Grandstands

Will there be any Grandstands at the event?(Required)

Number of grandstands, if any(Required)

Are the grandstands permanent or temporary?(Required)

Permanent

Temporary

If temporary, list name of the firm doing the installation.(Required)

What is the seating capacity of the grandstands?

Construction Type of grandstands(Required)

Safety Information

Emergency evacuation plan in place?(Required)

Yes

Qualified medical personnel in attendance?(Required)

Yes

Ambulance service in attendance?(Required)

Yes

Will there be any Musical Performers or Entertainers at the event?(Required)

MUSICAL/ENTERTAINMENT

Performer Entertainer Name?(Required)

Type of Performer(Required)

Local or National Entertainer?(Required)

Local

National

Add a 2nd performer?

Performer 2

Performer Entertainer Name?(Required)

Type of Music(Required)

Local or National Entertainer?(Required)

Local

National

Add a 3rd performer?

Performer 3

Performer Entertainer Name?(Required)

Type of Music

Local or National Entertainer?

Local

National

Add a 4th performer?

Performer 4

Performer Entertainer Name?(Required)

Type of Music

Local or National Entertainer?

National

Local

Entertainment

Is Dancing Permitted at this event?(Required)

Yes

Will there be a Parade at the event?(Required)

Yes

Parade Details

How many floats will be at the parde?(Required)

Number of Marching Units?(Required)

What will the Length of the Parade be?(Required)

1000 feet, 2 miles...???

Estimated number of spectators at the Parade?(Required)

Sporting Events

Will there be any Athletic games at the event?(Required)

Is this a Professional or Amateur event?(Required)

Professional

Amateur

Number of Games(Required)

Number of Spectators(Required)

How many Adult Participants / Players?

How many Youth Participants / Players?(Required)

Do you need Liquor Liability for this event.(Required)

Liquor liability protects you against claims or suits that arise from the incidental selling or serving of alcoholic beverages. This can include fights, falls, and even DUI's or car accidents.

Yes

Liquor Liability

What is the ESTIMATED number of attendees consuming alcohol each day?(Required)

Will you be the sole alcohol vendor at the event?(Required)

Yes

If “No,” List number of other Vendors serving alcohol(Required)

Are all participating alcohol Vendors required to carry minimum Liquor Liability Limits for the Event?(Required)

Yes

If “Yes,” what is the Minimum Requirement(Required)

Will alcohol be dispensed by a Professional Bartender?(Required)

Yes

If “No,” describe how and by whom alcohol will be dispensed:(Required)

Describe training and or experience of the people serving alcohol.(Required)

What measures are in place to prevent service of alcohol to minor and/or intoxicated persons?(Required)

Is a Liquor License required for this event?(Required)

Yes

Do you have a valid Liquor License for this event?(Required)

Yes

How many bars, stations or areas will alcohol will be dispensed at?(Required)

Will alcohol consumption confined to this (these) areas?(Required)

Yes

If “No,” describe(Required)

Will there be an open bar?(Required)

Yes

Will liquor sold by the drink?(Required)

Yes

What is the average cost per drink?(Required)

What is you estimated DAILY Alcohol Gross $ Sales?(Required)

Is BYOB (Bring your own bottle) permitted?(Required)

Yes

Food

Will food be sold or served?(Required)

Yes

If “Yes,” describe type of food available(Required)

What is you estimated DAILY Food Gross $ Sales?(Required)

Operational Underwriting

What are your total Estimated GROSS Receipts for entire period, including admission, food, beverage and concessions?(Required)

Is Haunted House an EXISTING STRUCTURE or TEMPORARY?

How many stories does the structure/house have?(Required)

Are all ENTRANCES, EXITS, and/or STEPS adequately lit?(Required)

Yes

Are all STAIRS and/or STEPS adequately equipped with Handrails?(Required)

Yes

Are there any RAMPS, SLIDES, TRAP DOORS or MOVING FLOORS?(Required)

Yes

If YES, please explain in detail(Required)

Will Live Actors be used in the Haunted House?(Required)

Yes

Will any Actors be in ANY TYPE of contact with Patrons?(Required)

Yes

If YES, please explain in detail.(Required)

Will Children under 6 years of age be required to be accompanied by an Adult?(Required)

Yes

Will any Animals, Reptiles, or “Hangman’s Nooses” be used?(Required)

Yes

Will any “Moonwalks” or similar devices be used?(Required)

Yes

Do you need to have any additional insureds added for this event?(Required)

Additional Insureds

Additional Insured Name(Required)

Additional Insured Address(Required)

Interest In the Event(Required)

Add a 2nd Additional Insured?

Yes please!

2nd Additional Insured

Additional Insured Name

Additional Insured Address

Interest In the Event

Add a 3rd Additional Insured?

Yes please!

3rd Additional Insured

Additional Insured Name

Additional Insured Address

Interest In the Event

Prior Insurance

How many years has this event been continuously insured?(Required)

3 or more

Has any insurance carrier cancelled or refused coverage?(Required)

Yes

If “yes”, please explain.(Required)

Last Year's Insurance Information

Total Premium(Required)

Carrier & Policy #(Required)

Total # of Claims(Required)

Total Claim $'s Paid(Required)

Prior year (2 years ago)

Total Premium(Required)

Carrier & Policy #(Required)

Total # of Claims(Required)

Total Claim $'s Paid(Required)

Prior year (3 years ago)

Total Premium(Required)

Carrier & Policy #(Required)

Total # of Claim(Required)

Total Claim $'s Paid(Required)

Which other coverages are you interested in or are required to have?

These are important, so don't take them lightly. If you have requirement you may need to satisfy, please take a look and make sure.

Cyber Liability/Data Breach(Required)

Can provide coverage for data breaches, network attacks, cyber fraud, ransomware, social engineering, attack & extortion. Over 50% of small business owners are victims annually, and the average breach can cost upwards of $200 per compromised record, so a breach of as few as 500 clients can cost $100,000.

Yes

Employment Practices Liability(Required)

EPLI, or Employment Practices Liability Insurance covers businesses and business owners against claims by workers, employees or ex-employees that their legal rights as employees have been violated. This can include harassment, wrongful termination, discrimination, wage & hour, breach of an employment contract, and even 3rd party claims like the American Disability Act.

Yes

Property & Inventory Coverage(Required)

Product and General liability insurance is a 3rd party coverage, it does not provide coverage for damage to property, real estate, equipment or inventory you own. This coverage provides insurance on the 'things' your company owns in the event that they are damaged or destroyed.

Yes

Business Income Coverage(Required)

Provides coverage for lost income in the event your business location is damaged or destroyed.

Yes

Event Cancellation Coverage(Required)

Provides coverage for lost income in the event your event needs to be cancelled due to external circumstances.

Yes

Workers Compensation(Required)

Workers Compensation is a state mandated coverage that provides no-fault insurance for your employees. Which means that it will pay regardless of fault for employee injuries while on the job. In essence if an employee in injured while performing a work related duty, then Workers Compensation insurance will pay a portion of that employees salary for a specified period of time as well as medical bills. If you have an employee that is injured while on the job, your company will be held liable for these costs.

Yes

What Cyber Liability / Data Breach Limit would you like?(Required)

How many individual personal records does your company store?(Required)

0-999

1,000-4,999

5,000-9,999

10,000-49,999

50,000-999,999

1,000,000 or more

Indicate what safeguards you have in place:(Required)

None

Mobile Device Encryption

Network Data Encryption

Compliance with Payment Card Industry Data Security Standards

Up-to-date, active firewall technology

Up-to-date, active anti-virus software on all computers, networks, and mobile devices

A process in place to regularly download and install patches

Backup and recovery procedures in place for all important data

An incident response plan to respond to a network intrusion

A disaster recovery plan, business continuity plan, or equivalent to respond to a computer

system disruption

Controls to ensure the content of media communications and websites are lawful

Multi-factor authentication for remote access to sensitive data

Employment Practices Liability

How many employees do you have?(Required)

What is your annual employee turnover?(Required)

Have you had any layoffs in the last 12 months?(Required)

How may layoffs have you had in the last 12 months?(Required)

Do you have any reason to believe that there is a pending employment practices claim that may arise?(Required)

If so, please provide details as to the nature of this claim.(Required)

Workers Compensation

What is your Federal Tax ID# (FEIN)

If you don't have it handy just say so, we'll send you an email requesting it.

Payroll & Classifications(Required)

Add additional lines for each state & job class

Classification

Location State

Annual Payroll

# of Employees

Property / Inventory Coverage

And a new line for each property location

Locations & Values for Property Coverage(Required)

Add a new line for each location and property type. Business property: Property the business owns in he building, furniture, fixtures, machinery... Improvements: permanent additions you have added to the space, Wall coverings, flooring, partitions...

St Address

Zip

Property Value

Prop Type

Burglar Alarm

Fire Alarm

Sprinklers

Location is

Final Authorization

If you have insurance requirements you need to satisfy, please upload them here.

Drop files here or

Accepted file types: doc, pdf, jpg, Max. file size: 100 MB, Max. files: 4.

Upload a FLYER or MAP of your event indicating it's attractions.

This is required in order to provide a quote. If you need to save your submission and return, please do so now using the save button at the bottom of this form.

Drop files here or

Accepted file types: doc, pdf, jpg, png, Max. file size: 100 MB, Max. files: 4.

Please provide any additional information we may not have asked and that you feel might be important for us to know.

Enter Your Name(Required)

Enter your name to acknowledge the following: 1. No Mechanical Devices or Machinery with Moving Parts 2. No Buildings Over One Story 3. No Chutes, Slides, Trap Doors, Movable or Sharply Inclined Floors 4. No Use of Live Animals 5. No Physical Contact or Jumping Out at Patrons by Actors 6. Warnings Posted for Pregnant Women and/or Those with Heart Conditions 7. No Open Flames 8. All Steps to be well Lighted and Include Handrails 9. Adequate Emergency Lighting 10. Exits Well Marked 11. Buildings Must Meet or Exceed Local Zoning and Fire Codes 12. Hayrides Must Be Tractor Drawn – No Horse Drawn Hayrides 13. Hayrides Must Be On Private Property – No Public Roads