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Campground Application

 

Named Insured: Date Completed:
Months of Operation: From to
Please Describe Agreements Customers Must Sign That Hold the Insured Harmless or Limit Liability(mail copies)

 

Operations and Revenues

 

Operations & Revenues
Select
Annual Revenues
if applicable
Additional Information
if applicable
 Site Rentals: Y N
$
 
Gifts/Groceries/Supply Sales: Y N
$
Fireworks Sales Y N
Amount $
Food/Drink Concessions: Y N
$
 

Excl. Alcoholic Beverages:

Y N
$
 

Alcoholic Beverages:

Y N
$
 
Restaurant/Bar/Tavern: Y N
$
 

Excl. Alcoholic Beverages:

Y N
$
 

Alcoholic Beverages:

Y N
$
 
Archery Range: Y N
$
Indoor Outdoor Supervised
Boat Rentals: Y N
$
powerboats
other boats
over 20' or 50HP
Climbing Wall: Y N
$
Height Ft
Daycare: Y N
$
 
Dock Rentals: Y N
$
Length:
# of Slips:
Lighted? Yes No
Exercise Room/Club: Y N
$
Area:
Game Room: Y N
$
Area:
Gasoline: Y N
$
Available at dock Y N
Go-Karts: Y N
$
Size of Track:
Maximum HP:
Fireworks Exhibitions Y N
$
# of Displays:
Hayrides: Y N
$
 
Holiday Events: Y N
$
See Below
Horseback Riding: Y N
$
# of Animals:
Maximum Group Size:
Kennel: Y N
$
Area # of Pets:
LP Gas: Y N
$
See Below
Paintball Range: Y N
$
See Below
Playground: Y N
$
Area
Pony Rides: Y N
$
# of Animals:
Roller-Skating: Y N
$
Area
Skiing: Y N
$
 
Spa: Y N
$
Area
Swimming: Y N
$
 
Vehicle Service or Repair: Y N
$
See Below
Water-Pond, Lake, Park, etc: Y N
$
 
Other: Y N
$
 
 
     
Does the Insured Meet the Following Minimum Requirements? Y N
Owner or Caretaker Resides on the Property Year Round; Average or Better Housekeeping; At Least 3 Years of Campground Management Experience; No Prior Bankruptcies; Currently Earning a Profit; No More than One Loss Greater than $25,000 in the Prior 3 Years and No Fatalities; Fire Detection and Suppression Devices are Present and Meet All Codes; No Firearm Ranges; Not in a High Crime Area/No Existing Signs of Vandalism or Malicious Mischief.
 
Complete for GENERAL LIABILITY Coverage:
 
Prior Losses: Describe all losses in prior 3 years, and any serious injuries or fatalities in last 7 years.
Any Other Activities: Describe any other activities not described above.
Above-Ground: Describe any activities that occur above ground. (Climbing Walls, "Ropes" Courses, etc.)
Boat Rental: Describe Boats Rented, any instruction given; employee experience; safety features; and loss
avoidance/control.
Events: Describe any holiday or other events and/or include brochure.
Kennel: Describe any free-roaming; staff number and experience; veterinary services.
LP Gas: How are tanks separated from the other operations and protected from vehicle damage?
Paintball: Describe any activities other than target shooting.
Playground: Describe the number and type of equipment; playing surface; other games available such as tennis, shuffleboard, horseshoes, badminton, etc.
Vehicle Servicing: Describe:
 
Complete for PROPERTY/CRIME/INLAND MARINE coverage only.
Commercial Cooking: Please complete the Concessions/Restaurant/Bar/Tavern supplement.
Fire Protection Systems: Describe
Distance to Water: How far is property from ocean or gulf?
Major Systems:
Roof: Age: Condition: Update Year:
Electrical Age: Condition: Update Year:
HVAC: Age: Condition: Update Year:
Plumbing: Age: Condition: Update Year:
Renovations: Are any renovations currently underway or planned?
Rented Structures: Describe rental of any living quarters including but not limited to tents, cabins and yurts.
Describe heating and cooking exposures including gas or wood stoves or fireplaces/firepits.
Site Plan: Please describe

Forms by Dime Store Designs