Haunted House Insurance Quote Request Haunted House Insurance Quote Request Step 1 of 7 14% 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)Corporation - For ProfitCorporation - Not For ProfitLLC - For ProfitLLC - Not For ProfitIndividual - Sole ProprietorTrustDescribe 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) FaxHahaha 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 No 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 No Is there an admission charge?(Required) Yes No 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, explainOpening 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 No Liability DetailsWhat liability limit do you need?(Required) 1000000 Other If other than $1,000,000 please specify(Required)$2,000,000$3,000,000$4,000,000$5,000,000$6,000,000$7,000,000$8,000,000$9,000,000$10,000,000Please specify which of the following will be present.Rides, mechanical devices, rebounding devices (ie: moonbounce, trampoline)?(Required) Yes No Petting Zoo, animal rides?(Required) Yes No Fireworks/Pyrotechnics?(Required) Yes No Are Vendors, Attraction Owners and Performers required to carry their own insurance?(Required) Yes No 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 No NA Security & StaffIs 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 No 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) No Yes GrandstandsWill there be any Grandstands at the event?(Required) N Y 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)ConcreteWoodMetalPlasticSafety InformationEmergency evacuation plan in place?(Required) Yes No Qualified medical personnel in attendance?(Required) Yes No Ambulance service in attendance?(Required) Yes No Will there be any Musical Performers or Entertainers at the event?(Required) N Y MUSICAL/ENTERTAINMENTPerformer Entertainer Name?(Required)Type of Performer(Required)They aren't musiciansAlternativeBlue GrassBluesChristianClassicalCountryDJ OnlyGospelElectronicHeavy MetalJazzPop / Yop 40PunkRap & Hip HopR&B / SoulRockLocal or National Entertainer?(Required) Local National Add a 2nd performer? Y Performer 2Performer Entertainer Name?(Required)Type of Music(Required)They aren't musiciansAlternativeBlue GrassBluesChristianClassicalCountryDJ OnlyGospelElectronicHeavy MetalJazzPop / Yop 40PunkRap & Hip HopR&B / SoulRockLocal or National Entertainer?(Required) Local National Add a 3rd performer? Y Performer 3Performer Entertainer Name?(Required)Type of MusicThey aren't musiciansAlternativeBlue GrassBluesChristianClassicalCountryDJ OnlyGospelElectronicHeavy MetalJazzPop / Yop 40PunkRap & Hip HopR&B / SoulRockLocal or National Entertainer? Local National Add a 4th performer? Y Performer 4Performer Entertainer Name?(Required)Type of MusicThey aren't musiciansAlternativeBlue GrassBluesChristianClassicalCountryDJ OnlyGospelElectronicHeavy MetalJazzPop / Yop 40PunkRap & Hip HopR&B / SoulRockLocal or National Entertainer? National Local EntertainmentIs Dancing Permitted at this event?(Required) Yes No Will there be a Parade at the event?(Required) Yes No Parade DetailsHow 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 EventsWill there be any Athletic games at the event?(Required) N Y 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 No Liquor LiabilityWhat is the ESTIMATED number of attendees consuming alcohol each day?(Required)Will you be the sole alcohol vendor at the event?(Required) Yes No 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 No If “Yes,” what is the Minimum Requirement(Required)$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000Will alcohol be dispensed by a Professional Bartender?(Required) Yes No 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 No Do you have a valid Liquor License for this event?(Required) Yes No How many bars, stations or areas will alcohol will be dispensed at?(Required)Will alcohol consumption confined to this (these) areas?(Required) Yes No If “No,” describe(Required)Will there be an open bar?(Required) Yes No Will liquor sold by the drink?(Required) Yes No 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 No FoodWill food be sold or served?(Required) Yes No If “Yes,” describe type of food available(Required)What is you estimated DAILY Food Gross $ Sales?(Required) Operational UnderwritingWhat are your total Estimated GROSS Receipts for entire period, including admission, food, beverage and concessions?(Required)Is Haunted House an EXISTING STRUCTURE or TEMPORARY?Existing StructureTemporaryHow many stories does the structure/house have?(Required)Are all ENTRANCES, EXITS, and/or STEPS adequately lit?(Required) Yes No Are all STAIRS and/or STEPS adequately equipped with Handrails?(Required) Yes No Are there any RAMPS, SLIDES, TRAP DOORS or MOVING FLOORS?(Required) Yes No If YES, please explain in detail(Required)Will Live Actors be used in the Haunted House?(Required) Yes No Will any Actors be in ANY TYPE of contact with Patrons?(Required) Yes No If YES, please explain in detail.(Required)Will Children under 6 years of age be required to be accompanied by an Adult?(Required) Yes No Will any Animals, Reptiles, or “Hangman’s Nooses” be used?(Required) Yes No Will any “Moonwalks” or similar devices be used?(Required) Yes No Do you need to have any additional insureds added for this event?(Required) N Y Additional InsuredsAdditional Insured Name(Required)Additional Insured Address(Required)Interest In the Event(Required)Add a 2nd Additional Insured? Yes please! 2nd Additional InsuredAdditional Insured NameAdditional Insured AddressInterest In the EventAdd a 3rd Additional Insured? Yes please! 3rd Additional InsuredAdditional Insured NameAdditional Insured AddressInterest In the EventPrior InsuranceHow many years has this event been continuously insured?(Required) 0 1 2 3 or more Has any insurance carrier cancelled or refused coverage?(Required) Yes No If “yes”, please explain.(Required)Last Year's Insurance InformationTotal 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 No 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 No 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 No Business Income Coverage(Required)Provides coverage for lost income in the event your business location is damaged or destroyed. Yes No Event Cancellation Coverage(Required)Provides coverage for lost income in the event your event needs to be cancelled due to external circumstances. Yes No 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 No What Cyber Liability / Data Breach Limit would you like?(Required)$25,000$50,000$100,000$250,000$500,000$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000$10,000,000How 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 LiabilityHow many employees do you have?(Required)What is your annual employee turnover?(Required)0%5%10%15%20%25%30%35%45%50%55%60%65%70%75%80%85%90%95%100% or moreHave you had any layoffs in the last 12 months?(Required) N Y 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) N Y If so, please provide details as to the nature of this claim.(Required)Workers CompensationWhat 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 classClassificationLocation StateAnnual Payroll# of Employees Clerical/OfficeManufacturingSalesWarehouseAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVIVTWAWIWVWY Add RemoveProperty / Inventory CoverageAnd a new line for each property locationLocations & 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 AddressZipProperty ValueProp TypeBurglar AlarmFire AlarmSprinklersLocation is Business Property InventoryBuildingImprovementsNoneLocalCentralNoneLocalCentralNonePartialCompleteLoc. we leaseLoc. we Own3PL Logistic Manufacturer's Add RemoveFinal AuthorizationIf you have insurance requirements you need to satisfy, please upload them here. Drop files here or Select files Accepted file types: doc, pdf, jpg, Max. file size: 6 GB, 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 Select files Accepted file types: doc, pdf, jpg, png, Max. file size: 6 GB, 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
