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AMUSEMENT DEVICES AND AMUSEMENT RIDES - KIDDIE
ONLINE QUOTE
Agent Information
Agent Name:
Agency Name:
Agency Phone:
Agent Email: (A copy of the quote will be sent to this address)
Insured Information
Insured Name:
Insured Mailing Address:
Insured City:
Insured State:* *Use postal abbreviations ONLY*
Insured Zip Code:

Amount of Coverage Required:
Device Information
Number of Batting Cages:
Number of Moon Walks:
Number of Space Walks:
Number of Moon Bounce(s):
Number of Ball Pits:
Number of Coin Operated Rides - Kiddie:
Number of Paddle Boats - Kiddie:
Additional Information
Is the Device Used by Adults?
Are Rules of Operation Posted Clearly On or Next to the Device?
State of Operation:
Is the Operation Seasonal?
Is Equipment Set Up, Tested, and Tied Down According to Industry Standards by an Experienced Employee of the Insured?
Is There a Rental Agreement Used Including Hold Harmless Wording In Favor of the Insured?
Does a Responsible Person Oversee the Operation and Acknowledge the Risks of Operation and are they Aware of the Hold Harmless Agreement?
Are Any of the Devices Larger than 16ft by 16ft?
Is Equipment to be Used in a Public Event?
If Equipment is Used in a Public Event, is it Attended at All Times?
Does the Insured Sell, Distribute, or Manufacture Amusement Devices?
Additional Information for Kiddie Rides and Paddleboats
Are Equipment and Operations Well Maintained?
Is Equipment Located Inside or In Front of a Store?
Are Paddleboats Well Supervised?
Are Floatation Devices Available for Paddleboat Operations?
Are Paddleboats Operated in More than 3ft of Water?



Only Commonwealth Underwriters, Ltd. has binding authority. Coverage will not be bound until application has been received, reviewed, and accepted by Commonwealth Underwriters, Ltd.

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Last modified 2007-12-05