Specialty Inflatables & Entertainment | Schiappa Insurance Agency

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To provide the most accurate quote, please fill in the application below in its entirety.
Turn around time is roughly 7-10 days to ensure we find the best coverage and price for you.
And let us know about your bull riding operation as we have a great option for savings.

FOR ANY QUESTIONS THAT DO NOT APPLY PLEASE TYPE N/A:
APPLICANT INFORMATION:
FIRST NAME:*
LAST NAME:*
COMPANY NAME INCLUDING DBA IF APPLICABLE:*
WEBSITE:*
BUSINESS ADDRESS:
STREET ADDRESS:*
CITY:*
ZIP CODE:*
STATE:*
ANY ADDITIONAL LOCATIONS:*
EMAIL ADDRESS:*
PHONE NUMBER:*
BEST TIME TO CALL:*
DATE BUSINESS STARTED UNDER CURRENT OWNERSHIP:*
IF LESS THAN 5 YEARS, PLEASE ANSWER THE FOLLOWING QUESTIONS:*
HAVE YOU WORKED ELSEWHERE IN A SIMILAR BUSINESS?*
HOW MANY YEARS?*
DO YOUR EMPLOYEES HAVE PRIOR EXPERIENCE?*
HOW MANY YEARS?*
FULL DECLARATION PAGE:

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LAST YEAR'S ANNUAL GROSS SALES:*
PROJECT CURRENT YEAR’S GROSS SALES:*
ANY POLICY OR COVERAGE DECLINED, CANCELLED OR NON-RENEWED DURING THE LAST THREE YEARS?*
FEIN:*
SPECIFIED INFLATABLES AND AMUSEMENT DEVICES:
DO YOU OFFER THE FOLLOWING TO YOUR CUSTOMERS:
USE THE DROPDOWN FOR YES OR NO AND ENTER THE ANNUAL RECEIPTS FOR ALL THE QUESTIONS ANSWERED AS "YES":
INFLATABLE RIDES/BOUNCE HOUSES:*
ANNUAL RECEIPTS:
INFLATABLE SLIDES:*
ANNUAL RECEIPTS:
SLIP N9 SLIDES (WATER USE):*
ANNUAL RECEIPTS:
CLIMBING WALLS(MUST BE ATTENDED):*
ANNUAL RECEIPTS:
MECHANICAL RIDES(MUST BE ATTENDED):*
ANNUAL RECEIPTS:
COIN OPERATED RIDES:*
ANNUAL RECEIPTS:
EURO BUNGEE/POWER BUNGEE JUMPING(MUST BE ATTENDED):*
ANNUAL RECEIPTS:
MINIATURE TRAINS(MUST HAVE AN OPERATOR):*
ANNUAL RECEIPTS:
MINIATURE TRAINS AGE OF OPERATOR:*
FOOD CONCESSION EQUIPMENT:*
ANNUAL RECEIPTS:
GO KART TRACKS - ELECTRIC(MUST BE ATTENDED):*
ANNUAL RECEIPTS:
GO KART TRACKS - ADULT(MUST BE ATTENDED):*
ANNUAL RECEIPTS:
GO KART TRACKS - KIDDIE(MUST BE ATTENDED):*
ANNUAL RECEIPTS:
ARCADES/GAMES/CRAFTS:*
ANNUAL RECEIPTS:
BATTING CAGES:*
ANNUAL RECEIPTS:
LASER TAG:*
ANNUAL RECEIPTS:
MINIATURE GOLF:*
ANNUAL RECEIPTS:
MECHANICAL BULLS(MUST BE ATTENDED):*
ANNUAL RECEIPTS:
PONY RIDES(MUST BE ATTENDED):*
ANNUAL RECEIPTS:
MISCELLANEOUS ATTRACTIONS (ALL OTHER):*
ANNUAL RECEIPTS:
LIST OF CURRENT INVENTORY AND VALUES:*

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Additional Information:
DO YOU HAVE A WRITTEN RENTAL AGREEMENT?
Attach Document

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DOES IT CONTAIN A HOLD-HARMLESS CLAUSE?*
COPY OF THE RENTAL AGREEMENT.:*

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DO YOU INSTALL/SET UP ALL UNITS FOR THE CUSTOMER?*
DO YOU HAVE A RENTAL CHECKLIST THAT IS REVIEWED WITH THE RENTAL CUSTOMER?
Attach Document

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PLEASE ATTACH A COPY:*

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DO YOUR AMUSEMENT DEVICES/RIDES HAVE SIGNS CLEARLY MARKING AGE, HEIGHT AND SIZE LIMITATIONS?*
DO YOU RENT ANY EQUIPMENT TO COMMERCIAL RISKS?*
ARE ALL OF YOUR RIDES INSPECTED ANNUALLY?*
ARE ALL RIDES MANUFACTURED, ASSEMBLED AND REGISTERED BY A U. S. BUSINESS ENTITY?*
IF FOREIGN MANUFACTURED, DO YOU HAVE EVIDENCE OF PRODUCTS LIABILITY INSURANCE COVERAGE FROM THE MANUFACTURER?*
DO YOU HAVE A MAINTENANCE CHECKLIST?*
DO YOU KEEP MAINTENANCE AND TEST LOGS AND PRE-OPERATION INSPECTION REPORTS ON ALL EQUIPMENT? *
DO YOU FOLLOW THE MANUFACTURER'S MAINTENANCE AND TEST SCHEDULE?*
DO YOU HAVE A TRAINING PROGRAM FOR EMPLOYEES?*
DO YOU PERFORM CRIMINAL BACKGROUND CHECKS ON EMPLOYEES?*
ARE YOUR EMPLOYEES TRAINED TO STRICTLY ENFORCE ALL RULES AND REGULATIONS EVEN IF IT MEANS STOPPING A RIDE EARLY OR REFUSING A RIDE TO A CUSTOMER?*
LOSS/CLAIM INFORMATION:
3 YEARS LOSS RUNS:

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DESCRIBE ANY LOSSES VALUED AT $25,000 OR MORE, INCLUDING DEFENSE COSTS IF APPLICABLE:*
The Applicant represents that the above statements are true and that no material facts have been suppressed or misstated.
e-signature:

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Specialty Inflatables

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Our Services

Insurance Made Simple

At SIA, we give you the best service because we know how important
you, your family, and investments are. Get your auto, home, or renters
quote started today with peace of mind and discover the SIA difference!

Specialty Inflatables

Start Your Quote

Our Services

Insurance Made Simple

At SIA, we give you the best service because we know how importantyou, your family, and investments are. Get your auto, home, or rentersquote started today with peace of mind and discover the SIA difference!

At SIA, we give you the best service because we know how important
you, your family, and investments are. Get your auto, home, or renters
quote started today with peace of mind and discover the SIA difference!