Pullen Insurance Services

Chartis launches aHead of the Game to bring awareness to the prevention and treatment of concussions.
Click here to learn more.

Pullen Insurance now offers Cyber Liability products for sports organizations.
Click here to learn more.

Current customers of Pullen Insurance can request a certificate of insurance online.
Click here for request.

Find Pullen Insurance on Facebook:

Please complete the form below to obtain an insurance quote from Pullen Insurance Services. A member of our team will contact you shortly.

1.	Applicant Company Name:
2.	Mailing Address
	Street Address:
	City:
	State:
	Zip Code:
3.	Facility Address
	Street Address:
	City:
	State:
	Zip Code:

4.	Contact Name:
	Contact Phone:
	Contact Email:
5.	Website:
6.	Tax ID Number:
7.	Applicant is:
8.	Requested Effective Date of Coverage:
9.	Requested Expiration Date of Coverage:
10.	Number of years in business:
11.	Number of years under current management:
12.	Type of facility:
13.	Area of facility:
14.	Number of staff (total):
	Fulltime:
	Part-time:
15.	List all sporting activities that take place:

16.	Type of protection used to safeguard spectators:

1.	Are the rules posted and enforced at all times?
2.	Are signs clearly posted to identify exits and hazards?
3.	Do participants wear safety equipment at all times?
4.	Are all participants required to sign an individual waiver and release form?
5.	Is the insured a member of a sanctioning body?

If yes, provide names:

6.	Are instructors employees of the insured?
	If no, are they required to provide certificates of insurance with limits equal to yours and an additional insured status to you?
7.	Are referees employees of the insured?
	If no, are they required to provide certificates of insurance with limits equal to yours and an additional insured status to you?
8.	Are parking lots well lit and/or patrolled?
9.	Are there procedures in place to suspend outside play during inclement weather?
	Describe:

10.	Are crews prepared and on duty to clean up spills?
11.	Are restrooms checked/cleaned during operation?
12.	Are any attending medical professionals available on the premises?
13.	Have you had or do you plan on scheduling any of the following activities?
	Bungee operation
	Events that have amusement devices present
	Iron Man/Tough Man events

1.	Does applicant operate a concession stand?
	If yes, is it self service?
	If yes, are there designated eating areas?
	If yes, cooking equipment is:
2.	Are there any grills and/or deep fryers on premises?
	If yes, are they equipped with hoods, automatic fire suppression systems and automatic fuel shutoff controls?

	If yes, how often is the system cleaned?
	List types of food / beverages sold: