Paintball Quote Application

Submission Requirements

We must receive a copy of these documents with the Applicant’s application.

Copy of the Applicant's Waiver, Release of Liability or Assumption of Risk form.
Diagram of premises. Please indicate all areas where netting is used. Show distance from areas of play to roads, other buildings, parking, registration, staging, chronograph and spectator areas.
Copy of the rules of play.
Currently valued insurance company loss runs for the current policy period plus 3 prior years.

Business Information

Proposed Effective Date*

Business Name*

Type of business*

Individual
Corporation
Partnership
Limited Liability Company

Contact First Name*

Contact Last Name*

Email Address*

Business Phone*

Fax

Cell

Business Website*

Mailing Address*

City*

State*

Zip Code*

My location is different from my mailing address

My location is different from my mailing address

Location Address*

City*

State*

Zip Code*

FEIN*

Date Business Established*

Detailed Description of Operations*

Insurance and Property Information

Current Insurance Carrier*

Exp. Date*

Any incidents or claims whether reported or not in the last five (5) years?*

Yes
No

Please explain*

Any policy declined, cancelled or non-renewed within the last three (3) years?*

Yes
No

Does the Applicant own or lease the Applicant's property?*

Own
Lease

Owner/Landlord Name*

Owner/Landlord Address*

City*

State*

Zip Code*

Other Additional Insured Name

Other Additional Insured Address

City

State

Zip Code

Paintball Games

Annual Gross Sales (Paintball Games)*

(indoor and outdoor)

Annual Number of Participants (Paintball Games)*

(indoor and outdoor)

Retail Pro Shop Sales

Annual Gross Sales (Retail Pro Shop Sales)*

(include offsite shops if applicable)

Annual Number of Participants (Retail Pro Shop Sales)*

(include offsite shops if applicable)

Equipment Rentals

Annual Gross Sales (Equipment Rentals)*

Annual Number of Participants (Equipment Rentals)*

Food and Drink

Annual Gross Sales (Food and Drink)*

Annual Number of Participants (Food and Drink)*

Other

Annual Gross Sales (Other)

(specify)

Annual Number of Participants (Other)

(specify)

Grand Totals

Annual Gross Sales Grand Total

(total gross sales from above fields)

Questionnaire

Does the Applicant provide: (Please check all that apply)

Select All
Airsoft
Archery Tag
Laser Tag
Nerf
Paintball
Gelly Balls

What is the youngest age permitted to participate in the above attractions?*

Is the facility:*

Indoor
Outdoor
Both

Does the Applicant's facility comply with Paintball Safety Guidelines shown at the end of this application?*

Yes
No

Years of paintball experience*

Years of management experience*

Is the facility enclosed or fenced?*

Yes
No

Does the Applicant have any inflatable, fabric, or air supported structures such as, but not limited to, bubbles or domes?*

Yes
No

Are waivers required for all participants?*

Yes
No

Reason why No:*

Please attach a copy*

Max. file size: 256 MB.

Are there rules of play and are they posted?*

Yes
No

Please attach a copy*

Max. file size: 256 MB.

Reason why No:*

Are goggles and safety masks, including ear protection, required at all times on the playing fields?*

Yes
No

Are safety signs posted in all playing areas?*

Yes
No

Describe all barriers and obstacles including their construction:*

Does the Applicant have any elevated structures?*

Yes
No

What is the height?*

Are there any ladders?*

Yes
No

Are there any stairs or ramps?*

Yes
No

Are they built to code?*

Yes
No

Do they have walls to prevent participants from jumping down?*

Yes
No

How many referees are on the field during play?*

What is the ratio of referees to players?*

Are referees instructed to stop play in the event of unsafe activities/participant injury?*

Yes
No

Are employees trained in first aid?*

Yes
No

Is customer's equipment checked before use to make sure it meets minimum safety requirements?*

Yes
No

Does an employee or staff member operate the fill station?*

Yes
No

Are they certified?*

Yes
No

By whom?*

Does the Applicant allow the following (please check all that apply)

Select All
First Strike Rounds
Paintball Grenades
Paintball Rocket Launchers

How often is the Applicant's equipment checked and velocity tested?*

Are maintenance schedules kept for all equipment?*

Yes
No

Is there a required safety meeting before all games?*

Yes
No

Are barrel blocker devices required in all non-playing field areas?*

Yes
No

Is the paintball field in a wooded area?*

Yes
No

Is the paintball field near any staging area, street or parking?*

Yes
No

Please describe:*

Does the Applicant use netting for all spectator areas?*

Yes
No

How many feet high is the netting?*

How many years old is the netting?*

If the Applicant has airsoft, does the Applicant keep players at least 60 feet away from the netting?*

Yes
No
N/A

Has the Applicant tested the netting within the last three months to comply with the ASTM standard of stopping paintballs when shot from 15 feet back into net, 10 shots at 300 feet per second within a 4" circle?*

Yes
No

Did it pass?*

Yes
No

Does the Applicant have boundary tape to keep spectators a minimum of 5" back from netting?*

Yes
No

Are there any special events or tournaments held on the Applicant's premises that the Applicant runs?*

Yes
No

Are there any special events or tournaments held on the Applicant's premises that are run by others?*

Yes
No

Are Certificates of Insurance obtained form those independent entities naming the Applicant as additional insured?*

Yes
No

Is there any overnight camping?*

Yes
No

Are there any night games?*

Yes
No

Are there any hayrides, zombie paintball or haunted attractions?*

Yes
No

Please describe:*

Are there other events or activities other than those listed above?*

Yes
No

Please describe:*

Attach copy of applicant’s waiver, release of liability or assumption of risk form

Drop files here or

Max. file size: 256 MB.

Attach diagram of premises

Drop files here or

Max. file size: 256 MB.

Please indicate all areas where netting is used. Show distance from areas of play to roads, other buildings, parking, registration, staging, chronograph and spectator areas.

Attach copy of the rules of play

Drop files here or

Max. file size: 256 MB.

Please attach Loss Runs from your prior Insurance Carrier(s), for the past 3 years. If this is your first year in business, please disregard. If you have been with Donat Insurance Services, LLC, for the past 3 years, please disregard.

Drop files here or

Max. file size: 256 MB.

Parental Guidelines

Field Operations
Strict control must be exercised over all areas including:
a. Field entrance
b. Sales and services
c. Parking areas
d. Spectator areas
e. Playing fields
f. Staging areas
Personnel
All field staff must be fully and properly trained. Referees and fill station attendants must be sixteen (16) years of age or older.
Emergency Procedures
All field staff must be trained to properly respond in the event of an accident or emergency and instructed to respond immediately. Field Staff must know the exact location of the field telephone, readily accessible first aid kit and incident report forms. Management must fill out and return an incident form immediately following all injuries.
Field Orientation
Prior to the first game, each player must undergo a formal orientation session including:
a. Detailed explanation of the player safety rules – clearly specifying those rules which result in player ejection.
b. Game rules
c. The geographical diagram of the field
d. Emergency procedures
e. Referees are assigned to each group at this time.
Barrel Blocking Device Regulation
The mandatory use of industry-approved barrel blocking devices (BBD) must be strictly enforced at all times in all non-playing areas of the field. Barrel plugs are no longer considered adequate protection due to differing barrel sizes and increased rates of fire. Operations must remain fully stocked to provide BBDs for all rental equipment and also for customers to buy if necessary. (Towels, socks, or stick squeegees are not considered BBDs).
Safety goggles
Mandatory goggle enforcement is required in all areas where “goggles on” signs are posted. Industry-approved full-face mask goggle systems must meet or exceed ASTM Guidelines which require:
a. Full enclosure of the eye cavity using 06 Lexan lenses secured within frames and to the head with a headband.
b. The face and ear protector components must be attached securely to the goggle frame to present full coverage (no gaps) to the bottom of the chin, along the jawbone, temples and ears.
c. Modifications are prohibited.
d. Wash, disinfect, and inspect goggles regularly.
Paintball Markers
Automatic markers that are in a mode of self-loading and shooting at a rate faster than one round per manual activation of the trigger’s cycle are allowed by UNDERWRITER APPROVAL ONLY. An additional premium may apply for coverage for activities involving ramping / multiple round burst modes. A semi-automatic marker does qualify for the program without approval if it is gravity fed or tractor fed at a rate of no more than fifteen (15) balls per second. In addition, off-premise marker rental is prohibited in this program.
Safety Signs
- “Goggles on” signs must be posted at every entrance to active play areas.
- “Barrel Blocking Device” signs must be posted at every exit of active play areas.
- “Caution! Paintball Game Area” signs must be posted at any location where the operators / field manager might expect unauthorized direct access to the active playing field.
Filling Stations
Only trained personnel are allowed to perform tank fills. Allowing players to fill their own tanks is prohibited. Only exception might be employed-supervised multi-fill air stations where tanks have already been checked that day. CO2 cylinders must be chained in an upright position. An on-site scale is required to prevent over-fill.
Trigger Guards
Trigger guards are mandatory on all paintball markers used by participants at the Applicant’s facility. The trigger guard must be rigid, wider than the trigger area, and enclose the trigger area.
Safety Netting
Netting (12" required, 20" recommended) must be installed around all play areas and must be maintained and checked regularly. Approved netting and / or 300 feet of open space must surround all areas of play. Carrier requires each operator to test the netting per ASTM Guidelines.
- Stand 15' from netting and shoot 10 shots at a 4" circle at 300 fps. No part of the paintball shell may pass through larger than 3 by 5 mm rectangle.
- Bunkers must be a minimum of 20' from the netting and spectators must be kept 5' away from the netting at all times.
Chronographing Procedures
Maintain at least one (1) chronograph (preferably two) with a back-up battery at the field at all times. All paintball markers must be chronographed before players enter the field and before each new set of games. A chronograph referee must be available at all times to strictly enforce velocity guidelines. Velocities must be adjusted so that three (3) consecutive shots through the chronograph do not exceed:

Paintball
- 300 (FPS) outdoor games
- 250 – 275 (FPS) indoor games
- Airsoft: 400 (FPS) outdoor games (20BBs)
- 300 (FPS) indoor games and close quarter (20BBs)
- 350 (FPS) outdoor games (25BBs)
- 300 (FPS) indoor and close quarter (25BBs)
- Snipers maximum velocity: 500 FPS and no shots closer than 100 feet to opponent. Sniper weapons must not have the ability to fire FULL AUTO. Underwriting approval is required for Sniper velocities that exceed 400 FPS
Field Maintenance
Boundaries of all outdoor playing fields must be clearly and continuously marked with rope, tape or other highly visible material. The field must be inspected frequently for natural or man-made hazards. Paintball markers must be cleaned and inspected weekly. A designated staff member must inspect the chronograph, first aid kit, mobile telephone, scale, fill station, CO2 cylinders, and all field equipment (including safety signs) daily.
Player Safety Rules
Each player / participant must read the player safety rules prior to signing the waiver of liability. The player safety rules must be posted at the field entrance and counter / sales office. Mandatory ejection (without warning!) of any player who knowingly violates the required safety rules is required – especially mask violation!

The Undersigned states that he/she is an authorized representative of the Applicant and declares to the best of his/her knowledge and belief and after reasonable inquiry, that the statements set forth in this Application (and any attachments submitted with this Application) are true and complete and may be relied upon by Company in quoting and issuing the policy. If any of the information in this Application changes prior to the effective date of the policy, the Applicant will notify the Company of such changes and the Company may modify or withdraw the quote or binder.

The signing of this Application does not bind the Company to offer, or the Applicant to purchase the policy.

Name*

Title*

Signature*

Date*

Electronic Signature Agreement*

By checking this box I acknowledge that the information I have entered is accurate and understand that the field above constitutes as my electronic signature.

Revenue Audit

I understand that written policies are subject to audit.

We understand both the attendance and receipt values are estimated values. With that, we strongly encourage you to give the most accurate estimate as possible. By doing so, it allows us to provide you with a quote that is as reflective of your needs as possible. In addition, all policies are subject to an audit upon expiration. Therefore, providing the most realistic estimate as possible, not only allows us to provide the most accurate quote, but will also aide in reducing the possibility of a large discrepancy in these estimates when audited, which could potentially result in additional premium charges.

Step 1 of 2

Submission Requirements

Business Information

Insurance and Property Information

Questionnaire

Parental Guidelines

Section to be Completed by the Producer/Broker/Agent