SPORTS VENUE

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?
UNDERWRITING INFORMATION
5. Please describe the operation of each named insured and their relationship to the first named insured
(use separate sheet if necessary)
6. / Est. Annual Admissions / Annual Payroll / No. of Employees / No. Yrs In Business
Please provide breakdown for the following:
a.Concession Receipts$
i.Food and drink$
ii.Liquor$
iii.Merchandise$
7. Date stadium/venue was constructed: / Date of any major reconstruction:
Primary construction material(s): / Stadium/venue capacity:
Stadium/venue square footage: / Sprinkler system? / Yes No
Permanent seating capacity: / Type of siren/smoke alarms:
Number of stories:
8. Does the facility have an emergency evacuation plan? Yes No
If yes, how often is the staff drilled on emergency evacuation?
9. Has emergency contingency plan been promulgated? Yes No
If yes, please provide a copy.
10. Are there any amusement rides, air inflatable structures, rock climbing walls, etc. on premises or brought on
premises temporarily? Yes No
If yes, please describe:
If yes, please complete the appropriate supplemental forms.
11.Any childcare services provided? Yes No
If yes, please describe:
If yes, please complete the Abuse and Molestation supplemental form.
12.Please specify who has responsibility for the following event day operations:
Sports Team / Other Lessor / Facility / Subcontractor
Facility Maintenance
Maintenance of Competition
Area (for sports events)
Concessions – Non Alcohol
Concessions – Alcohol
First Aid
Parking
Security
Premises Defects
PLEASE PROVIDE A COPY OF ALL SUBCONTRACTOR AGREEMENTS
13.Person responsible for general operation of facility activities:
Years of experience:
14.Any self-promoted events? Yes No
If yes, please describe:
CONTRACTUAL UNDERWRITING INFORMATION
15.Do entities using the facility list the proposed named insured as an additional insured? Yes No
If yes, what limit is required?
16.For instances where subcontractors are utilized, is the proposed named insured listed as an additional insured under the subcontractor’s policy? Yes No
17.Who has authority to sign contracts on behalf of the proposed named insured and what is the review
process?
18.Is there a system in place for obtaining certificates of insurance where applicable? Yes No
If yes, who reviews certificates on behalf of named insured?
What is the minimum limit of general liability coverage requested from each subcontractor?

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.)

19.Does applicant have a full-time Personnel Department? Yes No
20.Number of employees covered by Employee Benefit Program administered in the U.S. or Canada?
21.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
22.List below any other types of benefit programs the applicant wants the company to consider for inclusion under this insurance:
Type of Benefit Program
23.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
24.Is a benefit brochure or written explanation of the Employee Benefits Program given to each employee? Yes No
25.Are all benefits available to all employees? Yes No
If no, list all exceptions:
26.Who advises the employees of their benefits?
Personnel Manager / Department Manager / Immediate Supervisor / Other (Please describe):
27.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
28.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:
29.Has any occurrence taken place in the past that is likely to give rise to a claim? Yes No
If yes, please give details:
30.Number of branches, other business locations:
31.How are employees in branches and other locations advised of benefits?
32.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.)

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

C.PYROTECHNICS

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

54. Do you have Fireworks? Yes No
If yes, please complete the following questions.
55. 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.
56. Name of contractor:
57. Is there an agreement with the contractor? / Yes No
If yes, please provide a copy of the agreement.
58. Do you confirm that the contractor has secured the proper pyrotechnic permits for each event? Yes No
59. Description of Events:
60. Location of Events:
Street / City / State / Zip
61. Dates of Events:
62.Who is the Authority having jurisdiction over the use of pyrotechnics at your facility?
Local Fire Department State Fire Marshal Other (please list):
63.What permit process must be followed prior to use of pyrotechnics at your facility:
64.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)65. 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
66. 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:
67.Describe what fire prevention and suppression measures are taken to support the pyrotechnic loading and firing process:
68. Are events with pyrotechnics held: Indoors Outdoors
OUTDOOR PYROTECHNICS (only complete if outdoor pyrotechnic displays are staged)
69.Are the events in compliance with NFPA 1123 or 1126 (Code for Fireworks Display)? Yes No
70.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:
71.Will there be firefighting equipment on site during the event? Yes No
72.If no firefighting equipment on site, give distance to nearest fire station:
73.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)
74.Are the events in compliance with NFPA 1126 (Standard Code for the Use of Pyrotechnics before a Proximate Audience)? Yes No
75.What other form of fire fighting equipment is available at the facility?
76.Number of accessible (not locked) emergency exits at the facility:
77.What steps are taken to inform patrons of the locations of all emergency exits?
78.Has the fire marshal approved the use of pyrotechnics at the facility? Yes No
If yes, as of what date:

D.SECURITY COVERAGE

79.Do any security personnel carry a firearm as part of their equipment while on duty? Yes No
If yes, number of armed security personnel:
80.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:
81.Are the security persons employed or contracted by the insured? 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:
82.Total maximum hours per day permitted at this and all other places of employment:
Total maximum hours per week?
83.What are the staffing guidelines per number of patrons?
84.Are the guidelines determined by: Ordinance, or Statute?
Industry standard? Yes No
Other (please describe):
85.Is there a pre-employment screening procedure? Yes No
If yes, please describe:
86.Does the procedure include contacting previous employers over the previous five years? Yes No
87.Do you contact at least three personal references? Yes No
88.Is a psychological screening profile used? Yes No
If "yes," what type:
89.Is a criminal background check made? Yes No
If "yes," what agency is used for the criminal background check?
90.Is completion of a minimum 20 hours initial training program required before deployment? Yes No
91.Is a minimum of 10 hours on-site training required? Yes No
92.Is a minimum of 4 hours of annual refresher or continuing education training planned and conducted for each
security employee? Yes No
93.Is each security person given a personal copy of the training/safety manual? Yes No
If "yes," has each security person given the insured written acknowledgment of the policies and contents?
Yes No
NOTE: PLEASE INCLUDE A COPY OF THE MANUAL & A SAMPLE OF THE WRITTEN ACKNOWLEDGMENT.
94.Are the security personnel in uniform? Yes No
If "yes," please describe the uniform:
95.Are the security personnel identified by other than a uniform? Yes No
If "yes," please describe the identification.
96.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
97.Describe capabilities of each guard for constant communications with each other, the supervisor, and insureds
management:
98.Are dogs used in your security operations? Yes No
If yes, please provide the type of dog(s), number, and describe duties.
99.Does the supervisor make personal contact with each security person at least once during each shift?
Yes No
If "yes," please describe:
100. Please explain all "no" answers.

E.TRANSPORTATION

101. Do you have a valet service or garagekeepers exposure? Yes No
If yes, please provide a completed ACORD Garagekeepers and/or Garage Liability Application
102.Does the facility allow the use of employees’ personal autos for company business? Yes No
If yes, number of people employed by the facility:
103.Does the facility rent vehicles? Yes No
If yes, is rental coverage purchased from the rental agency? Yes No
Estimated number of rental days:
General description of the exposure (transport athletes, employees run errands, etc., rental/lease, contracted transportation, hauling):
104.Is there a written policy w/respect to the use of company vehicles? Yes No
If yes, explain:
105.Are employees allowed to use company vehicles for personal use? Yes No
106.Explain the driver selection process (age review, independent MVR review, confirmation of primary insurance, proof of valid drivers license):
107.What does the facility do if an individual is found to have three or more moving violations or a DUI or an OUI-type of violation?
108.Does the facility have a driving safety/training program? Yes No
109.Are there protections in place at the area where vehicles are stored? Yes No
If yes, please explain:
110.Is there a concentration of values or exposure (major exposure is within a certain time frame) with respect to this insured? Yes No
If yes, explain:
111.Does insured travel to Canada or to Mexico?Yes No
112.Description of any high valued vehicles (over $75k):
113.What’s the majority radius of the auto fleet?

Do you have inflatables, hot tubs and/or climbing walls? Yes No

If yes please complete supplementals.

Please provide the following with this application:

  • Five years of currently valued company loss runs.
  • Most current audited financials.
  • Copy of expiring policy or specific manuscript endorsements that the insured would like to submit for consideration.
  • Copy of at least thetable of contents of your written emergency evacuation and contingency plans
  • List of all insureds to be included along with a description of each.
  • Copy of lease agreement (if not owned)
  • Provide copies of standard lease agreements and actual leases of anchor tenants and multi-event tenants.
  • Provide details of other contractual agreements (contractor and sub-contractors (e.g., concessionaires, liquor, security, maintenance)
  • Provide copies of certificates of insurance from all contractors and sub-contractors naming the insured as additional insured
  • List of entities that require insured to list each as additional insured

SECURITY

  • If Security is contracted, please provide a complete copy of contract, a copy of the contracted security liability policy if insured is listed as additional insured by contract, and a copy of the security firm’s employment procedures.
  • Copy of the event Emergency/Crisis Response plan and/or Risk Management Manual
  • Provide copy of certificate

I hereby represent and confirm that I have read all of the questions and answers contained herein and that, to the best of my knowledge, the information is true and correct.

I further acknowledge that I understand that this information is provided in conjunction with and in addition to the ACORD application(s) referenced above and that the information contained herein is subject to the same notices, disclaimers, warranties, and representations as on the referenced application(s).

DateSignature of Insured or Authorized RepresentativeTitle

Send completed form along with referenced ACORD application(s) to:

American Specialty Insurance & Risk Services, Inc.

7609 W. Jefferson Blvd.

Suite 100

Fort Wayne, IN 46804

Phone:(800) 245-2744

E-mail:

Form No. I/A AMSP.SPORTS.VEN.QUESTIONNAIRE (10/14)Page 1 of 9 SP # 5998337

American Specialty Insurance & Risk Services, Inc. dba A.S.I.R.S.I. Insurance Agency, American Specialty Insurance & Risk Services Agency, and

A S Insurance & Risk Services Agency. All rights reserved.