Indoor Family Fun Center Application

Please attach the following:

  • Current insurance carrier loss report of the past 5 years, if this is not a new business
  • Copy of the waiver and copy of your posted safety rules
  • If leasing your space, send a copy of the lease
  • If a new business, provide a copy of your resume and business plan

Your General Information

Please Indicate The Forms of Coverage You Are Interested In:

Liability Underwriting Questions

Provide your estimate of anticipated annual sales gross receipts – Mark N/A if doesn’t apply

Please attach a list of all Amusment Related Equipment in the Center with the following information:

  • Manufacturer
  • Type
  • Age of Item
  • Dimensions
  • Value
  • Serial Number

Property Underwriting Questions

Please read and sign below:

To the best of my knowledge and belief, the information provided in connection with this application is true and I have not withheld any information.

I declare that the statements made in this application are complete and true to the best of my knowledge. I agree that any intentional concealment or misrepresentation of a material fact concerning this insurance application or the subject thereof may void any policy issued.

Signing this form does not bind Friedman Insurance, Inc. or the insurance company to any insurance contract. I understand Friedman Insurance, Inc. may obtain additional information in order to evaluate acceptability for insurance such as but not limited to, credit reports, motor vehicle records, survey or inspections of covered operations or prior claim experience verification. I hereby authorize the agency to obtain such information.