Special Events Questionaire - Greater Insurance Service,

Need help? Call: 1-888-636-7174

Home | Products | Resources | About Us | Contact Us

SPECIAL EVENTS QUESTIONAIRE
WE PROVIDE INSURANCE COVERAGE FOR MINNESOTA ONLY

If you prefer mail it to:
RECOVERSOURCE • PO BOX 309 • GRAND RAPIDS, MN 55744
You can fax it to us at:
218-326-8510
Questions? Call us at 1-800-851-4291

ALL FIELDS MUST BE FILLED IN

Name:

Name of Group:

Policy Number:

Address of Meeting Site:
(Designated Premises)*

City:

State:

ZIP:

Description:

Date(s): Number of Participants:

Time: Revenue Generated:

SWIMMING? Yes No
IF YES:
Are lifeguards on duty? Yes No
Are they hired by our insured at place event is being held? Yes No
Are they lifeguard certified? Yes No
Certificate received by insured? Yes No

IS ALCOHOL BEING SERVED? Yes No
IF YES:
Are bartenders hired by our insured at place event is being held? Yes No
Are they trained in T.I.P.P.S. Yes No
How is the drinking limited:
(For example, are tickets given out?) Yes No
Certificate received by insured? Yes No

IS A SPORTING ACTIVITY BEING PLAYED? Yes No
IF YES:
Which Sport?
Are participants required to sign a waiver? Yes No
Do participants have to show proof of personal health insurance? (participants are currently excluded under standard CGL) Yes No
Are safeguards in place to prevent injury to spectators? Yes No

Organizations or agencies which will need to be named as Certificate Holder and/or Additional Insured including their interest in the event (such as City or County or building owner):
Are you sure the Certificate holder needs to be named as an Additional Insured? Yes No
Do we need to provide a certificate of insurance? Yes No
If so, give date by which certificate must reach this organization:
Address of certificate holder:

Additional comments::