Bookmark this site!

Club Champion®
Comprehensive Property and Liability Application

All coverage is subject to a satisfactory loss control survey and compliance with any deficiency recommendations. It is also dependent on verification and approval of prior loss history.

1. Applicant Named Insured(s):
(If more than one named insured, describe the relationship between each named insured and the golf club):
2. Location Address: City: State: Zip:
3. Mailing Address: City: State: Zip:
4. Club Owner/Manager: Phone: Email:
a. If current ownership/ management for less than 3 years describe prior experience:
5. Contact for Inspection: Phone: Email:
6. Is Course?: Public(Daily Fee)   Semi-Private   Private   Municipal   Resort 
7. For Coastal States: Distance to sea coast (miles):
8. Current Policy Expiration Date: Ins. Company: Premium $:
9. In the past 3 years have you had any losses over $2500 whether covered by insurance or not?
If yes, explain in detail in this section?:

SNACK BAR/ RESTAURANT

1. Snack bar or restaurant on premises?: Yes No Operated by? Insured Operated by? Concession
2. If cooking, is fire suppression sys. UL300 compliant? YES: NO: # fire hydrants on site:

ALCOHOLIC BEVERAGE
(If requesting Liquor Law Liability coverage, please complete this section)

1 .Does insured serve alcoholic beverages? YES:   NO: Type? Liquor:    Beer:    Wine:
2. If not by insured, by whom: Are they insured?  YES:   NO:
a. any past suspensions or revocation of liquor license?: YES:   NO:
b. if alcohol is sold by others, are certificates of insurance required naming our insured as an additional insured? YES: NO:
6. Dance floor on premises? YES: NO: If YES, size? square feet?:

PRO SHOP EXPOSURE

1. Pro Shop on premises? YES: NO: If yes, operated by insured?:
or, leased to golf pro or others?:
a. If leased to pro or others, does lessee provide the insured with certificates of liability insurance with limits equal to or greater than those carried by insured and naming insured as additional insured? YES: NO:

GOLF CART EXPOSURE

1. # of Golf Carts? Owned: # of Golf Carts? Leased: # of 3 wheeled carts?:
a. If carts are leased, does lessor provide insured with certificates of insurance with equal to or greater than those carried by insured and naming insured as an additional insured? YES: NO:

SWIMMING POOLS

1. Number of swimming pool(s) on premises?: Location of Pool?: Indoor?: Outdoor?:
2. Is the pool open to the public?: YES NO: members only?: public and members?:
3. Pool Depth range? From (feet): to feet?: Depth properly marked YES?: NO:
Floatation Rope installed?: YES: NO: Non slip decking and walkways?: YES: NO:
4. Any diving boards or slides?: YES: NO:
5. If necessary are anti-vortex drain covers installed?: YES: NO: N/A
6. Are Life Guards in duty while pool is open?: YES: NO:
Explain Life Guard qualifications?:

ADDITIONAL INFORMATION

1. Explain any non-golf activities such tennis, horse riding, ice skating , sledding, snowmobile, ATV, fireworks, target shooting, babysitting, boats, fitness centers, entertainment, etc. that are conducted at premises (excluding swimming)?:
a) Other than golf clubs, is any equipment rented to participants?: YES: NO:
2. Is there a lightning detection/notification system?: YES: NO: If yes, explain:

If Stop Gap Liability and Non-owned & Hired Automobile Liability are being requested please complete below:

Total Payroll $: Limit: Hired Auto: # of employees:

The following must be completed for all submissions

4. Please provide the gross (annual) receipts from the golf facility operations arising out of the following

A. Greens fees (public/semi private courses) $:
B. Membership fees $:
C. Guest greens fees (private courses) $:
D. Cart rentals $:
E. Pro shop sales (clubs, clothing, balls, etc) $:
F. Snack bar $:
G. Restaurant $:
H. Liquor/Beer/Wine $:
I. Driving range receipts $:
J. Private function receipts (ie. Weddings) $:
* K. Other misc. receipts (explain in comments section) $:
Total Annual Gross Receipts $:
5. Number of 9 hole rounds annually: Number of 18 hole rounds annually:
Additional coverage request and related information:

COVERAGE LIMITS
(All quotations are $1000 Ded., 90% co-insurance, Replacement Cost, Broad Perils Form)

Building
Description		 Year
Built		 Replacement
Value (Bldg.)		 Replacement
Value (Conts.)		 Construction
F,JM,NC		 Sprinklers
Yes/No		 Alarm
S,F,B		 Type
L,CS		 Hydrant
Distance
                 
For Buildings over 15 years old, please provide any information concerning renovations or dates when the last inspections were made to the Heating, Plumbing, Electrical and Roof.

COURSE MAINTENANCE EQUIPMENT


1. Total actual cash value (ACV=replacement cost less depreciation) of all course maintenance equipment including golf carts. $ $1000 per loss deductible will apply. An itemized schedule will be required to bind coverage.
2. Where is equipment stored when not in use?:
Any Additional Comments?

If you have any questions, please feel free to call us at (800) 662-2141. When you have finished completing the application, click SEND to submit to Fairway D/S for your proposal.

Fairway D/S
191 Pawtucket Boulevard
Lowell, MA 01854
Phone: 1-800-662-2141
Fax: 978-454-8740
[email protected]

back to top

  © Copyright Fairway D/S - Powered by web design vt: SimpleNation.com