Shooting Range Supplemental Application GENERAL INFORMATIONBusiness Name Effective Date MM slash DD slash YYYY Website Current Carrier InformationCarrier Limit of Insurance Deductible Premium Offering renewal? Yes No Claims made? Yes No Please attach copies of the following:Currently valued five year loss runs, including claim detail for all losses open or exceeding $15,000 Drop files here or Select files Max. file size: 512 MB. Product brochure, catalog, or marketing materials if a website is not available Drop files here or Select files Max. file size: 512 MB. Detailed diagram of lanes and ballistic paneling/backstops; ventilation equipment (for indoor ranges) Drop files here or Select files Max. file size: 512 MB. What are your operations? Check all that apply Shooting Range – Public – Indoors Shooting Range – Public – Outdoors Shooting Range – Private/Gun Club – Indoors Shooting Range – Private/Gun Club – Outdoors Shooting Range – Law Enforcement/Military Only – Indoors Shooting Range – Law Enforcement/Military Only – Outdoors Firearm Obstacle Course – Soft Round, Airsoft, Paint or other Marker Firearm Obstacle Course – Live Fire Ammunition Firearm Amusement Center – No Aircraft, Tank, or Military Vehicle Firearm Amusement Center – No Aircraft – Utilizing Tanks or Military Vehicles Firearm Amusement Center – Utilizing Aircraft Explosives Range or Fireworks Launching Site Firearms Training Site – Firearms Safety – Instructed by You or On Your Behalf (please complete Kinsale Firearm Instructor App) Firearms Training Site – Firearms Safety – Instructed by Others/Private Instructors Firearms Training Site – Tactical Use – Instructed by You or On Your Behalf (please complete Kinsale Firearm Instructor App) Firearms Training Site – Tactical Use – Instructed by Others/Private Instructors What are your projected receipts for the coming year?Do you operate seasonally only? Yes No What is your operating season? Are you subject to any state or local licensing or regulation? Yes No List regulations/licenses: How many years have you been in operation? Do you run criminal background checks on all employees? Yes No Are past convictions for violent crimes, organized crime, and “straw sales” violations exclusionary criteria for hiring? Yes No What is the minimum age for employment? Does your operation have any age restrictions for participants? Yes No What age? Do you strictly prohibit the use of firearms by any participants under the influence of drugs or alcohol? Yes No Are all participants required to sign a waiver absolving you of all liability for bodily injury and property damage, including any damage to their firearms? Yes No Do you have the following first aid measures readily accessible in all areas where firearms are discharged:Basic first aid kit? Yes No First aid trained staff? Yes No Advanced aid kits (such as gunshot, hemorrhage, tourniquet)? Yes No Emergency alert button/911 call button? Yes No Do you sell any products? Yes No Do you sell firearms? Yes No Ammunition? Yes No Personal protective equipment? Yes No Ballistic armor? Yes No Other SHOOTING RANGESPlease indicate the personal protective equipment required on the rangeEar Protection? Yes No Eye Protection? Yes No Other How many lanes do you have? How many people may occupy a lane? How many range safety officers are present at all times? Do you require new shooters to attend a range safety presentation? Yes No Do you require periodic reviews of the range safety presentation? Yes No How often? Do you rent firearms? Yes No Do you rent any Title II/NFA firearms? Yes No Do you allow new shooters to rent firearms? Yes No Are new shooters who arrive solo allowed to rent? Yes No How frequently are rented firearms cleaned and inspected? Do you allow the use of Title II/NFA firearms at the range? Yes No Do you have any restrictions on the types of ammunition allowed on the range? Yes No Do you require that shooters use ammunition purchased at the range? Yes No Do you allow the use of any incendiary, “dragon’s breath”, or explosive rounds? Yes No Do you allow the use of any armor piercing rounds? Yes No If you operate any outdoor ranges, please complete the following:Do you allow shooting before sunrise or after sunset? Yes No Please describe range lighting Do you allow the use of binary composite, sparking, or explosive targets? If yes, please complete the Explosives Ranges or Fireworks Launching Sites section of this application. Yes No Do you have any skeet, clay pigeon, clay target, or similar shooting? Yes No How many shooters are permitted to fire each pull? Do you allow shooting from any position other than forward facing upright, seated, or prone? Yes No Please clarify Do you require shooters to keep both hands on their firearm while shooting? Yes No If your range is used as a firearms training site, please complete the following:If instruction is privately coordinated/not conducted by you or on your behalf, do you require instructors to provide proof of insurance? Yes No Do you require all instructors to be certified, regardless of any state or local requirements? Yes No FIREARM OBSTACLE COURSESAre your courses limited to law enforcement, licensed private security, or military personnel only? Yes No If no and you allow live fire, do you have a mandatory minimum proficiency exam before course participation? Yes No What is the minimum accuracy threshold? How many participants may be on the course at one time? Is any bodily contact made with course participants at any point in the course? Yes No Is this contact made by another person? Yes No Does any bodily contact involve the use of electroshock devices or chemical irritants (such as Taser or pepper spray devices)? Yes No Do any courses involve the use of climbing or rappelling? Yes No Do any courses involve low light or vision obstruction (nighttime, smoke, strobing lights, etc.)? Yes No Are in-person observers allowed on course location during runs? Yes No How are observers protected from projectiles? Are observers limited to adults 18 (eighteen) years of age or older? Yes No Do any courses utilize fire, pyrotechnics, or explosives? Yes No Do any courses utilize other environmental hazards (intense wind, rainfall, noxious odors, etc.)? Yes No Is the ground or flooring of all courses firm and non-skid in all areas where the participant may discharge their weapon? Yes No FIREARM AMUSEMENT CENTERSDo you allow participants to shoot fully automatic firearms that are not mounted to a bench, vehicle, seat, or other fixture? Yes No Are participants required to be over 21 (twenty-one) years of age or over 16 (sixteen) years of age and accompanied by a parent or guardian over the age of 25 (twenty-five)? Yes No Height and weight minimums, if applicable What is the largest caliber arm that can be shot from an unmounted fully automatic weapon? If you are utilizing non-aircraft vehicles, please complete the followingAre participants permitted to drive? Yes No Are participants required to place the vehicle in park before shooting? Yes No Are you utilizing any tanks? Yes No Is the tank cannon operational and intended to be fired by participants? Yes No What type of round is fired? Yes No If you are utilizing aircraft or rotorcraft, please complete the following:Are flights conducted open door? Yes No How are participants secured in the aircraft? Does any portion of the flight path go over water? Yes No Are all passenger restraints designed to allow for rapid egress? Yes No How many pilots do you employ or contract? How many flight hours does each pilot have in the type of craft you are operating? Do you own the craft you use? Yes No Are you responsible for regular maintenance of the craft? Yes No Do you carry aircraft liability insurance including passenger and public liability? Yes No How frequently are firearms cleaned and inspected? EXPLOSIVES RANGES OR FIREWORKS LAUNCHING SITESWhat type(s) of explosive do you allow to be used at your facility? Attach additional pages if neededDo you require clients to have an explosives permit or special licensing to use your facilities? Yes No Is your facility a testing facility/professional use only? Yes No Do you sell or provide explosives or fireworks? Yes No Please describe How are explosives stored and secured when not in use? What is the maximum yield you allow to be detonated at your site? What detonation methods do you permitLit fuse ? Yes No Pin and lever fuse/thrown? Yes No Timer? Yes No Pressure or wire tripped? Yes No Gunshot/explosive target? Yes No Radio/remote? Yes No ACCOUNT HISTORYDuring the past five years, has any insurer ever canceled or non-renewed similar insurance to any applicant or has your insurance been canceled for nonpayment of premium by any insurance or finance company. Yes No Please attach Drop files here or Select files Max. file size: 512 MB. Please explainIs your company aware of any occurrences, facts, circumstances, incidents, situations, damages or accidents arising out of or related to your operations that a reasonably prudent person might expect to give rise to a claim or lawsuit whether valid or not which might directly or indirectly involve the company? Yes No Please attach Drop files here or Select files Max. file size: 512 MB. Please explainApplicant Title FEIN # Date MM slash DD slash YYYY
