Contact Us Home Page Get A Quote Customer Service Home Page
Secured by SSL

Inflatable Insurance


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

General Information
First Name
Required
Last Name
Required
Corporate or LLC Name
Required
FEIN # or DBA Name
Optional
Mailing Address
Required
City
Required
State / Province
Required
ZIP / Postal Code
Required
Location Address
Required
Location City, State, Zip Code
Required
Primary Phone Number
Required
Cell Phone Number
Required
Fax Number
Optional
E-Mail Address
Required
Date Business Started Under Current Ownership
Required
/ /
Current Insurance
Have you been previously insured?
Required
Current Insurance Provider
Optional
Nature of Business
Please select the option that best describes the nature of your operation
Required
If other, please describe other business operations:
Optional
Revenue Breakdown
Revenue from misc rentals and supplies (Mobile Game Shows, Carnival Type Game Booths, Cash Cubes, Video Games, Pin Ball Machines, Skee or Skeet Ball, Putting Challenge, Foosball, Air Hockey, Pop A Shot*
Required
*Also: Football Challenge, Pool Tables, Spin Art Pictures, Oriental Name Writing, Rice Art Jewelry, Candle/Sand/Candy Art
*Also: Wax Hands, DJ/Sound/Video Equip., Photo Booths, Disco Ball, Old TIme Photos, Table/Yard Bowling, Simulators w/o motion, Hi-Striker, Batting Cage Game with Tee, Advertising Signs
Revenue from simple mechanicals (Trikes, small & large mechanical devices, Bumper Boats and Cars, Trackless Trains
Required
Revenue from interactive inflatables (air filled amusements and devices such as Slides, Bounce Houses, Combo Bounce Houses with Slides, Obstacle Courses)
Required
Revenue from interactive devices (direct interaction between participants such as Paint Ball, Dunk Tanks, Mini Golf Driving Ranges, Putting Greens*
Required
*Also: Boxing Games, Lazer Tag, Hay Rides, Simulators with Motion, Velcro Wall
Revenue from Physical Activity Devices (Euro Bouncers/Bungee, Rock Walls WITH Auto Belay, Jousts, Jacobs Ladder, Bungee Runs
Required
Revenue from physical activity devices II (Rock Walls WITHOUT Auto Belay Systems, Electric Bulls, Go Carts, Haunted Attractions, Batting Cage with Pitching Machine
Required
Revenue from physical activity devices III (Orbitrons with motors (only) Sumo Suit, and simiilar - Air Bots, etc.)
Required
Revenue from entertainment services (Clowns, DJ, Magicians, etc.)
Required
Are they subcontracted or Employees?
Optional

Are background checks done?
Optional

If subcontracted, do you get copies of their certificate with limits equal to yours?
Optional

Revenue from food and beverage products and rentals (Hot Dog Cookers, Nacho/Popcorn Machines, Snow Cone/Frozen Drink Machines, Chocolate Fountains, Warm Pretzel/Cotton Candy Machines, Ice Cream Sundae Bar
Required
Revenue from tables, tents and chairs
Required
Revenue from restaurants & snack bars
Required
Revenue from catering
Required
Revenue from party planning
Required
Revenue from other - Please Describe
Required
Revenue from subcontracted devices (please also describe)
Required
If subcontracted, do you get copies of their certificate with limits equal to yours?
Optional

Revenue from Hydraulic Bull, Orbitron without Motor, Zorb balls, Water Balls, Hamster Balls
Required
TOTAL REVENUES
Required
Inflatable Information
Height Measured from Ground to Platform
Number of Small Slides 15' and under
Required
Number of Medium Slides over 15' to 22'
Required
Number of Large Slides over 22' to 26'
Required
Number of Giant Slides over 26'
Required
Number of Combo Slides with Bouncer
Required
Rockwall Information
Do you have a rockwall?
Required
Is the Rockwall Supervised by a trained operator at all times?
Optional

Is the tool loop cut off from the safety harness?
Optional

When the Rockwall is not is use, how and where do you store it?
Optional
How often are the cables replaced?
Optional
Is the Rockwall manual or auto belay?
Optional
Other Equipment
Do you have a bungee trampoline?
Required
Obstacle Course Information
Please include Length, Width, and Height of Obstacle Courses and number of each
Small: H___ x W___ x L___ and number of each
Required
Medium: H___x W___x L___ and number of each
Required
Large: H___x W___ x L___ and number of each
Required
Risk Assessment
Please provide details to any "Yes" answers
Do you have an employee safety program?
Required
Do they sign documentation after said program?
Optional

Do you provide written operating instructions for scheduled equipment?
Required
Do you utilize an inspection sheet for inflatable and mechanical amusement rides?
Required
Is there a formal ride/equipment maintenance program including maintenance logs?
Required
Is equipment stored inside?
Required
Is your yard secured?
Required
Please select the formal safety training that applies:
Optional




Risk Management
Please provide details to any "Yes" answers
Is there a rental agreement between you and your client?
Required
Percentage of time your rental agreement was used without alteration
Optional
Percentage of time a customer provided contract is used
Required
Percentage of customers you do business with that are individuals
Required
Percentage of customers you do business with that are corporations and/or schools
Required
Percentage of customers you do business with that are governmental
Required
Number of owners & officers active in business
Required
Total number of staff during the year (DO NOT include owners)
Required
Number of Full Time Employees:
Required
Number of Part-time Employees
Required
Number of Seasonal Employees
Required
Equipment Rental Information
Do you rent any of your amusement devices/rides without operators/attendents?
Required
If yes, what percentage is without operators?
Optional
Do you have a customer training program?
Required
If yes, do they sign documentation after said program?
Optional
Do the amusement devices/rides have signs clearly marking age, height, or size limitations?
Required
Is any equipment left over night at the site where it was used?
Required
Do you use the manufacturer's checklist for the set up and use of the equipment?
Required
Do you utilize the Watchdog Siren Warning Device?
Required
What percentages of your inflatable rentals use a Watchdog Siren Warning device?
Optional
Indoor Fun Facility Information
Do you have an indoor fun facility?
Required
How many rooms & total square footage
Optional
Is it in a stripmall or other building?
Optional

Any drop offs?
Optional

Must parents stay with child?
Optional

Hours of operation, Monday - Friday
Optional
Hours of operation, Saturday
Optional
Hours of operation, Sunday
Optional
Is an attendant always there?
Optional

Do you have:
Optional





Mechanical Bull Information
Do you have a mechanical bull?
Required
Is Mechanical Bull hydraulic drive or electric?
Optional

Is Mechanical Bull located at a fixed site or mobile?
Optional

Please check all venues where Mechanical Bull will be operated
Optional



Please describe other venues of operation
Optional
Submission Validation
Required
CAPTCHA
Change the CAPTCHA codeSpeak the CAPTCHA code
 
Enter the Validation Code from above.
Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
First Commercial Insurance Agency
Ph (386) 775-1781 - Fax (386) 775-3666