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Please complete form to the best of your ability.
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Full Legal Name of the Organization:
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Type of Organization
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IndividualPartnership
CorporationOther
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If Other:
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Location of Club::
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Mailing Address:
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Phone Number:
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Website:
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Contact Person:
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Phone:
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E-mail:
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Secondary Contact:
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Secondary Contact Phone:
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Secondary Contact E-mail:
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All documents will be e-mailed to you unless specified here:
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General Questions
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Check box if you you offer gunsmith services.
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Check box if you offer rental or sales of fully automatic guns.
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Are more than 15% of your annual revenues generated from firearms sales
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Do you provide any ATV rental, organize ATV trail rides or provide ATV trails/routes?
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Are ATV’s or snowmobiles provided for clients or members?
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Are UTV’s (side-by-side seating) provided for clients or members?
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Do you have tree stands or raised/elevated platforms?
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Are alcoholic beverages provided or consumed without a charge?
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a. Are ID’s checked to verify the age of those being served?
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b. Are procedures in place for the handling of intoxicated patrons?
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Are there youth hunting programs?
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Are clients or members required to sign waivers prior to joining or participating?
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Do you reload or sell reloaded ammunition?
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Please describe any non-archery activities that are conducted at your club:
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Number of family memberships:
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Number of Individual memberships:
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Number of Archery Ranges (not targets)?:
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Number of acres:
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Leased
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Owned
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Number of tournaments?:
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Average number of entrants:
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Largest tournament number of entrants?:
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Number of sporting clay, trap, skeet stations?:
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Number of lakes, ponds, rivers or similar water exposures?:
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What is the area of the Club House?:
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Sq Feet
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Gross Receipts
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Club Memberships:
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Pro Shop:
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Hunting Preserves:
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Hotel and Lodging:
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Boat Rental:
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Guns:
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General Liability Coverage |
• General Liability Aggregate $3,000,000
• Products / Completed Operations Limit $2,000,000
• Personal / Advertising Injury Limit $1,000,000
• Each Occurrence Limit $1,000,000
• Fire Legal Liability $300,000
• Medical Payments To Others $5,000
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Optional Coverage
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Coverage $25,000 - Employee theft, forgery or alterations; Theft, robbery, burglary (Deductible $250)
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Crime Coverage
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Such as targets, portable 3D targets, mowers, tractors
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Equipment Coverage
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Limit Requested:
(Premium Deductible $500)
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Property
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BUILDING 1
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Amount of Insurance:
(Deductible $1000)
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Contents:
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Address of Building:
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Construction:
(Frame, Cement Block, Pole Barn)
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Roofing Material:
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Age of Roof:
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Year Building Built:
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Number of Stories:
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Total Square Footage:
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Alarms:
(Burglar, Fire, Video, Sprinkler, etc. If none, please state)
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UPDATES:
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Electrical
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Heating / Cooling
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Plumbing
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Roof
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If any updates, please note year of updates.:
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BUILDING 2 |
Amount of Insurance:
(Deductible $1000)
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Contents:
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Address of Building:
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Construction:
(Frame, Cement Block, Pole Barn)
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Roofing Material:
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Age of Roof:
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Year Building Built:
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Number of Stories:
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Total Square Footage:
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Alarms:
(Burglar, Fire, Video, Sprinkler, etc. If none, please state)
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UPDATES:
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Electrical
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Heating / Cooling
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Plumbing
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Roof
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If any updates, please note year of updates.:
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Upon submission, your form will be sent to an agent who will contact you
for additional details and information.
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