Horse Track Liability Insurance Questionnaire

HORSE TRACK LIABILITY INSURANCE QUESTIONNAIRE

• NOTE: This questionnaire is to be submitted along with the following completed forms:
• ACORD Applicant Information application 125
• ACORD Commercial General Liability Section 126
• ACORD Applications for other requested coverages: Property; Garage; Crime; Inland Marine; Transportation; Excess Liability; Employment Related Practices.

GENERAL INFORMATION
1. Name of Insured (Applicant):
2. What is the insured’s FEIN number?
3. What is the insured’s website address?
4. Number of years in business?
5. Effective Date Coverage Requested:
UNDERWRITING INFORMATION
6. Track Location:
Street / City / State / Zip
7. Does the insured engage in any other business operations under the name shown above? Yes No
If yes, explain:
8. Do you own or lease the facility? Own Lease
9. Number of years the current management has operated the track and details of management experience:
10. Does the track employ a risk manager? Yes No
11. Type of racing: Thoroughbred Harness Quarterhorse Other
12. Who is responsible for the following operations?
Parking / Insured / Subcontracted / Specify Company: / N/A
Security / Insured / Subcontracted / Specify Company: / N/A
Maintenance / Insured / Subcontracted / Specify Company: / N/A
Concessions / Insured / Subcontracted / Specify Company: / N/A
Liquor / Insured / Subcontracted / Specify Company: / N/A
First Aid / Insured / Subcontracted / Specify Company: / N/A
Fireworks / Insured / Subcontracted / Specify Company: / N/A
Do all subcontractors carry liability limits at least equal to $1,000,000? Yes No
Is facility listed as an additional insured, indemnified and held harmless? Yes No
Please provide copies of all applicable contracts and certificates of insurance.
13.Live race dates: / through
Total number of days:
Simulcast dates:
Total number of days:
14.Estimated annual attendance: / Live: / Simulcast:
Average daily attendance: / Live: / Simulcast:
15. Do you own or operate any off track betting locations? Yes No
Address:
Street / City / State / Zip
Annual Admissions: / Estimated Annual Payroll:
16. Do you have slot machines? Yes No
If yes, how many?
Do you have other gaming devices? Yes No
Explain:
Estimated Annual Casino Admissions: / Estimated Annual Payroll:
17.Do you hold non-racing events at your facility (concerts, festivals, car shows, trade shows, flea markets, etc.)? Yes No
If yes, please describe:
Estimated Attendance:
For events conducted by third parties, are certificates of insurance collected that name the facility as an additional insured? Yes No
Please provide a copy of the facility rental agreement required for special events.
18.Are any construction projects planned for the coming year? Yes No
(Construction means: new buildings, additions, added walls/ceilings/floorsand demolition)
If yes, explain:
19.Please complete the following:
Total Annual Receipts
A. Admissions:
B. Restaurant:
C. Liquor:
20.Are grounds completely fenced? Yes No
If no, explain:
21. / Total grandstand capacity: / Year built: / Type of construction:
Total clubhouse capacity: / Year built: / Type of construction:
Total bleacher capacity: / Year built: / Type of construction:
22.What percentage of grandstand/clubhouse is sprinkled?
Are fire extinguishers easily accessible in all buildings? Yes No
What is the distance to the nearest fire station?
23. Are there any playgrounds/campgrounds/amusement areas on site for which coverage is desired? / Yes No
If yes, please explain:
24.Is a log kept of inspections completed and maintenance performed throughout the facility? Yes No
25.Medical Services
Do you have on-site medical assistance? Yes No
Number of the following on-site:
Doctors: / Nurses: / EMTs:
Ambulances: / First Aid Stations:
Does the track employ any EMTs or other medical providers? Yes No
If yes, please explain:
26.Horse Legal Liability
# barns: / # stalls:
Please indicate the construction of barns/stables (frame, joisted masonry, masonry non-combustible, fire resistive, etc.):
What percentage of barns/stables are sprinkled? / %
Please indicate fire protection available (fire extinguishers, hydrants, central station alarm, security personnel, video surveillance, etc.):
How often is track inspected?
Has track been found liable for injury to, or death of, any horses in the past 5 years? Yes No
If yes, explain:
Are stables maintained during off season? YesNo
Are employed veterinarians on site during races? Yes No
Please attach a copy of the current Stall Agreement.
27.Participant Legal Liability
Are all jockeys/drivers covered by workers compensation? Yes No
If yes, who is the statutory employer?
Is any accident medical coverage provided for jockeys? Yes No
By whom:
Limit:
Carrier:
Is any accident medical coverage provided for harness drivers? Yes No
By whom:
Limit:
Carrier:
Is any accident medical coverage provided for other individuals who work with the horses (hotwalkers, outriders, groomsmen, exercise riders, etc.)? Yes No
By whom:
Limit:
Carrier:
28.Dormitories/Living Quarters
Do you provide dormitories for jockeys/drivers? Yes No
# of dorms:
Capacity of each:
Construction:
% sprinklered:
Age:
Smoke/fire alarms present? Yes No
Are hotplates or open flames allowed in the living quarters? Yes No
Is anyone other than jockey/driver allowed to utilize dorms? Yes No
If yes, explain:
Are dorms provided during the off season for any purpose? Yes No
If yes, explain:
Please provide a copy of Dorm/Living Quarters Agreement and copies of any rules, procedures or safety plans.
29.Patron Services
Are buses or trams used on premises? Yes No
If yes, are shuttle drivers required to carry a CDL? Yes No
Are MVR's obtained annually for shuttle drivers? Yes No
Are curbs, steps and ledges highlighted? Yes No
Are grandstand/clubhouse exits clearly marked? Yes No
Are stairways and emergency exit routes equipped with emergency lighting? Yes No
How are spectators prevented from entering the stall area?
How are spectators prevented from entering the track area?
30.Parking
Do you provide valet parking? Yes No
Do valet drivers complete any kind of vehicle inspection? Yes No
Explain:
Are MVRs obtained annually? Yes No
Are criminal background checks conducted? Yes No
Are any shuttle services provided for patrons? Yes No
Explain:
Are criminal background checks conducted? Yes No
Explain key controls:
Are vehicles ever driven across a public road? Yes No
Is the lot manned by an attendant when open? Yes No

A.EMPLOYEE BENEFITS LIABILITY

(Please complete this section if you need a quote for Employee Benefits Liability Coverage. If you do not need a quote for Employee Benefits Liability, please skip this section and continue to the next section.)

31.Does applicant have a full-time Personnel Department? Yes No
32.Number of employees under Employee Benefit Program administered in the U.S. or Canada:
33.Employee Benefit Programs which are automatically covered without being specifically listed by the applicant are (check all that apply):
Group Life Insurance / Group Accident or Health Insurance / Profit Sharing Plans / Pension Plans
Employee Stock Subscription Plans / Workers' Compensation / Unemployment Insurance
Disability Benefits Insurance / Social Security Benefits
34.List below any other types of benefit programs the applicant wants the company to consider for inclusion under this insurance:
Type of Benefit Program
35.On programs permitting employees an option to enroll or not to enroll, does the applicant require a signed acceptance or rejection from each employee? Yes No
If yes, is the signed acceptance or rejection retained in the employee's personnel file? Yes No
36. Is a benefit brochure or written explanation of the Employee Benefits Program given to each employee? Yes No
37.Are all benefits available to all employees? Yes No
If no, list all exceptions:
38.Who advises the employees of their benefits?
Personnel Manager / Department Manager / Immediate Supervisor / Other (Please describe):
39.Is there a review of employee questions and a record kept as to each employee's acceptance or rejection of any one or all the benefits? Yes No
40.Has any Error and Omission loss ever been sustained or is any such claim pending against the applicant?
Yes No
If yes, please give details:
41.Has any occurrence taken place in the past that is likely to give rise to a claim? Yes No
If yes, please give details:
42.Number of branches, other business locations:
43.How are employees in branches and other locations advised of benefits?
44.What is the first date any previous Employee Benefits Liability coverage was carried?

B.LIQUOR LIABILITY

(Please complete this section if you need a quote for Liquor Liability Coverage. If you do not need a quote for Liquor Liability, please skip this section and continue to the next section.)

45. Are you requesting this coverage be: Primary Excess
46. Do you have a bar that is open year round? Yes No
47. Do you stop serving at least one hour prior to closing? Yes No
48.Name on liquor license:
49.Liquor license number: / Class of license:
50.Has applicant's liquor license ever been revoked or suspended? Yes No
If yes, please explain:
51.Has applicant incurred claims for liquor liability during the last 3 years? Yes No
If yes, please explain:
52.Has any insurer cancelled or non-renewed coverage during the last 3 years? Yes No
If yes, please explain:
53.Has applicant ever been fined by alcoholic beverage control or other governmental regulator? Yes No
If yes, please explain:
54.Type of beverages sold:
55.Are patrons allowed to carry alcoholic beverages onto the premises? Yes No
If yes, what type?
56.Do you exercise the right of search and seizure of contraband items? Yes No
If yes, how do you notify the public of this?
57.Are the alcohol sales and consumption:
Contained within one fixed site, or Are booths/stands located throughout the event site?
58.Do you use Volunteer Servers? Yes No
If yes, please explain supervision:
59.Do all servers receive alcohol awareness training? Yes No
If yes, please explain:
(attach training manuals used)
60.Explain how ID's are checked:
61.Are rules and regulations clearly displayed for patrons viewing? Yes No
Describe:
62.Is there a limit placed on the quantity of alcoholic beverages purchased at one time? Yes No
Explain:
63. Is there entertainment provided? Yes No
Live music? Yes No
Disc Jockey? Yes No
Type of music:
64.Is the parking area patrolled to prevent intoxicated drivers from leaving the premises? Yes No
Explain:
65.Is there any type of designated driver program? Yes No
Explain:

C.SECURITY COVERAGE

(Complete only if security is the responsibility of the insured.)

66. Are security cameras on site? Yes No
Please advise number of Security Cameras.
Describe areas covered.
Please describe the process of locating, retrieving and security tape in case of incident.
67.Do any security personnel carry a firearm as part of their equipment while on duty? Yes No
If yes, number of armed security personnel:
68.Who is primarily responsible (via contract) for liability coverage for security personnel?
Insured Municipality Subcontractor
Number of security personnel on staff:
Number of security supervisors:
Number on premises:
Number off premises:
69.Are the security persons employed or contracted by the park? Employed Contracted
("Employed" means the individual is being paid and supervised directly by the insured. "Contract" means the existence of a
written contract with another entity for security services that has insurance coverage separate from the insured's policy for
security liability.)
Note:
If “Contracted”please provide a copy of the contract as well as a Certificate of Insurance showing the Named Insured as Additional Insured.
If "Employed" please answer the following questions:
70.Total maximum hours per day permitted at this and all other places of employment:
Total maximum hours per week?
71.What are the staffing guidelines per number of patrons?
72.Are the guidelines determined by: Ordinance, or Statute?
Industry standard? Yes No
Other (please describe):
73.Is there a pre-employment screening procedure? Yes No
If yes, please describe:
74.Does the procedure include contacting previous employers over the previous five years? Yes No
75.Do you contact at least three personal references? Yes No
76.Is a psychological screening profile used? Yes No
If "yes," what type:
77.Is a criminal background check made? Yes No
If "yes," what agency is used for the criminal background check?
78.Is completion of a minimum 20 hours initial training program required before deployment? Yes No
79.Who conducts the training and what are the trainers qualifications:
80.Is a minimum of 10 hours on-site training required? Yes No
81.Is a minimum of 4 hours of annual refresher or continuing education training planned and conducted for each security employee? Yes No
82.Is each security person given a personal copy of the training/safety manual? Yes No
If "yes," has each security person given the park written acknowledgment of the policies and contents?
Yes No
NOTE: PLEASE INCLUDE A COPY OF THE MANUAL & A SAMPLE OF THE WRITTEN ACKNOWLEDGMENT.
83.Are the security personnel in uniform? Yes No
If "yes," please describe the uniform:
84.Are the security personnel identified by other than a uniform? Yes No
If "yes," please describe the identification and include an example or photograph.
85.Please indicate any equipment carried or routinely available to security personnel:
Flashlight / Handcuffs
Night Stick / Taser/Phaser
Chemicals (Mace, pepper gas) / First Aid Kit (including blood borne pathogen kit)
Other:
Firearm - Caliber:.357.38.9mmOther:
Make:ColtS&WRugerOther:
Covered HolsterType:
Is Ammunition:StandardOther:
Firearm and ammunition approved and inspected by park or security company? Yes No
86.Describe capabilities of each guard for constant communications with each other, the supervisor, and park
management:
87.Are dogs used in your security operations? Yes No
If yes, please provide the type of dog(s), number, and describe duties.
88.Does the supervisor make personal contact with each security person at least once during each shift?
Yes No
If "yes," please describe:
89.Please explain all "no" answers.

D.PYROTECHNICS

(Please complete this section if you need a quote for Pyrotechnics Coverage. If you do not need a quote for Pyrotechnics,please skip this section and continue to the next section.)

90. Do you have Fireworks? Yes No
If yes, please complete the following questions.
91. Who will be the Pyrotechnics operator?
Named Insured - Not eligible for Pyrotechnics coverage
Contractor –
Please provide a Certificate of Insurance showing the Named Insured as Additional Insured and complete the following questions.
92. Name of contractor:
93. Is there an agreement with the contractor? / Yes No
If yes, please provide a copy of the agreement.
94. Do you confirm that the contractor has secured the proper pyrotechnic permits for each event? Yes No
95. Description of Events:
96. Location of Events:
Street / City / State / Zip
97. Dates of Events:
98.Who is the Authority having jurisdiction over the use of pyrotechnics at your facility?
Local Fire Department State Fire Marshal Other (please list):
99.What permit process must be followed prior to use of pyrotechnics at your facility:
100.Have you staged pyrotechnic displays before? Yes No
If yes, please list any claims/losses that have occurred and the amount of loss:
Description / Date of Occurrence / Amount of Loss
A.
B.
C.
(6)101. Do you allow tenant users (including temporary tenant users) to conduct pyrotechnic displays either themselves or through a contractor? Yes No
If yes, what steps are taken to ensure that the appropriate permits are granted, appropriate fire safety codes are
met, and that insurance has been obtained from either the tenant or the tenant’s contractor which lists you as an
Additional Insured?
If no, does the tenant lease/use agreement indicate that pyrotechnic displays are not permitted? Yes No
102. What type of pyrotechnics will be displayed (as defined in NFPA code 1126)?
Aerial Shells Airbursts Black Powder Comets
Concussion Effects Concussion Mortars Electric Matches Flares
Flash Pots Flashpowder Integral Mortars Wheels
Mines Mortars Rockets
Other, please list:
103.Describe what fire prevention and suppression measures are taken to support the pyrotechnic loading and firing process:
104. Are events with pyrotechnics held: Indoors Outdoors
OUTDOOR PYROTECHNICS (only complete if outdoor pyrotechnic displays are staged)
105.Are the events in compliance with NFPA 1123 or 1126 (Code for Fireworks Display)? Yes No
106.Is there fencing to keep spectators away from restricted areas during the fireworks shooting? Yes No
If yes, distance of spectator fencing from launch site:
Distance of spectator parking area from launch site:
Distance of closest building or structure from launch site:
107.Will there be firefighting equipment on site during the event? Yes No
108.If no firefighting equipment on site, give distance to nearest fire station:
109.Will you have an ambulance on site? Yes No
If no,(a) what is the estimated response time of an ambulance?
(b) distance to nearest medical facility:
INDOOR PYROTECHNICS (only complete if indoor pyrotechnic displays are staged)
110.Are the events in compliance with NFPA 1126 (Standard Code for the Use of Pyrotechnics before a Proximate Audience)? Yes No
111.What other form of fire fighting equipment is available at the facility?
112.Number of accessible (not locked) emergency exits at the facility:
113.What steps are taken to inform patrons of the locations of all emergency exits?
114.Has the fire marshal approved the use of pyrotechnics at the facility? Yes No
If yes, as of what date:
RESTAURANT/FOOD SERVICE OPERATIONS (Complete if team is responsible for concessions)
115.Are cooking installations in compliance with NFPA 96? Yes No
116.Are all cooking surfaces protected by automatic fire extinguishing systems? Yes No
117.Are automatic fire extinguishing systems serviced by outside contractor? Yes No
If yes, frequency of service: / Date last serviced:
118.Are hoods/duct work cleaned by outside service contractor? Yes No
If yes, frequency of service: / Date last serviced:

Please provide the following with this application:

• Five years of currently valued company loss runs.
• Copy of current audited financials.
• Copy of expiring policy or specific manuscript endorsements that the insured would like to submit for consideration.
• List of all locations to be insured, including addresses and descriptions of each location.
• List of all insureds to be included along with a description of each.
• Provide a copy of the medical coverage policy available to jockeys/drivers
• Provide a diagram and photos of track
• Copy of Lease Agreement (if not owned)
• Copy of all contractor and sub-contractor agreements and/or contracts including copies of certificates of insurance from all contractors and sub-contractors (e.g. food service, liquor, security, maintenance)
• Provide a schedule of events and all activities and ancillary events including description of each or a brochure for each event.
• Copy of facility rental agreement if special events are applicable; i.e., flea markets, festivals, concerts)
• Attach a copy of the current Stall Agreement.
• Provide a copy of Dorm/Living Quarters Agreement and copies of any rules, procedures or safety plans.
• Copy of written emergency evacuation plan
• Copy of Dormitory or Employee Accommodation Agreement
• Copy of Employee Handbook

SECURITY