BOWLING APPLICATION

General Information

Named Insured:
Contact Name:
Mailing Address:
Telephone:
Fax:
Email:
Insured is: Individual
Partnership
Corporation
Other:
Expiration date: (../YYYY)
Expiring Policy Premium:
Current Member of BPAA? Yes No
Do you desire a finance plan? Yes No
Number of years in business:


Property Section

Location name & Address:
Building Value*
Business Personal Property**
Sales (Annual)
Liquor Sales (Annual)
Inside City Limits: Yes No
Sprinklered: Yes No
Year built:
# Stories:
Basement: Yes No
Construction:
Square footage:
# of Signs/Value
Location name & Address:
Building Value*
Business Personal Property**
Sales (Annual)
Liquor Sales (Annual)
Inside City Limits: Yes No
Sprinklered: Yes No
Year built:
# Stories:
Basement: Yes No
Construction:
Square footage:
# of Signs/Value

* Building Value should include improvements & betterments, fencing, lights, permanently installed fixtures and machinery such as pinsetters, automatic scorers, attached signs, etc.

** Business Personal Property should include computers, furniture, fixtures, etc.


Crime

Employee Dishonesty Coverage - $500 deductible (check desired limit):

$10,000 $25,000 $50,000

Theft, Disappearance and Destruction ? Inside and Outside - $500 deductible (check desired limit)

$1,000 $2,500 $5,000 $10,000

Number of employees who handle or have custody of money:


Auto

Any autos owned by the bowling center? Yes No

Year, make & model Vehicle ID# Comp. Deductible Coll. Deductible Cost New


Umbrella

Excess Liability coverage desired? Yes No
Limit: $1,000,000 $2,000,000


Child Care

Do you provide child care for bowlers? Yes No


Loss History

List all losses for the current year and past three years: (Property - i.e.: fire, smoke, theft, wind, hail, water damage, etc.; General Liability - i.e.: slip & fall, lawsuits, etc.)

Date of Occurence Description Amount Paid Amount Reserved Open or Closed

Describe any losses over $10,000:


Warranty

I hereby certify that all the above statements are true and correct to the best of my knowledge.

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