Tanning Salon Insurance Quote Form

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Copyright 2000 [Thompson-Gusic Insurance Group, Inc.].  
ALL RIGHTS RESERVED

      Tanning Salon Insurance     

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-    Normal Lead Time to provide a quote is 3 weeks if all information is provided.
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GENERAL INFORMATION

Legal Business Name:
(as you file your taxes)

 Contact:

D/B/A Name

 Phone: 

Mailing Address:

 Fax:

City:

State:  Zip:  Email:

Type of Entity:

C. Corp.  S. Corp.    LLC
Partnership   Individual    Non-Profit
 Website: www.

Year Business Established:

     Years Experience in Field:  Quote Need by Date EXPLANATION:

Federal ID #:

 How many locations do you have?

Check if Member of:  

ITA (Indoor Tanning Assoc    Smart Tan    or List Other Assoc:
   How Many Employees do you have:   Full Time     Part Time

 POLICY INFORMATION

 Have you, or anyone else in your company, completed other insurance applications to obtain quotes either in writing or over
 the phone EXPLANATION
Yes  No
 1. What is your proposed Effective Date EXPLANATION?  2. Are you a new business / new venture with no current policy?
 
Yes  No  If YES, CLICK HERE to SKIP to YOUR COVERAGE
 3. What COMPANY are you with now?  4. What is your current premiumEXPLANATION?
 5. Is your current policy being Non-Renewed?Yes  No  
 6. What General Liability Occurence Limit & Professional Liability Limits do you currently have?
     General Liability "Occurrence"?
         Professional Liability?

CLAIMS / LOSS HISTORY PAST 5 YEARS

 CHECK HERE if you have NOT had any insurance claims in the past five (5) years.  You may SKIP to Next Section (YOUR COV.)
  Otherwise, please complete below.

Date of Loss

Description of Loss

Amount Paid

 Are there any more claims than above?Yes  No

YOUR COVERAGE

 What type of coverage do you desire?     Liability Coverage Only          Liability & Property Coverage
 Where are your tanning beds located in? Tanning Salon   Store      Hotel     Health Club    Beauty Shop
 
Other: Describe

EXPLANATION LIABILITY LIMITS  & COVERAGE APPLICABLE TO ALL LOCATIONS

 Choose your General Liability Occurrence Limit EXPLANATION:
 Choose your General Liability Aggregate Limit EXPLANATION:
 Choose your Professional Liability Limit EXPLANATION:
 Do you wish to carry Employee Benefits Liability EXPLANATION? Yes  No

LOCATION #1 (ONLY) INFORMATION FOR LIABILITY COVERAGES
If you have Additional Locations they will be accommodated after Submitting this form with a Supplemental Form

 Physical Address (Enter Street, City, State, Zip):
 Total #?  Tanning Beds  Tanning Booths  Spray Booths  Table  Toning  Air Brush
 What is total Replacement Cost value of all above? You may leave this blank if you are not requesting Property Coverage
 What is estimated annual # of sessions for tanning at this location EXPLANATION?    MUST BE ANSWERED
 What is estimated annual sales from tanning at this location
EXPLANATION?    MUST BE ANSWERED
 Do youOwn orLease the Space?  IF Leased, does your Landlord require an Additional Insured Certificate?Yes  No
 Do you own any Autos? Yes  No
 OTHER SERVICES OFFER AT THIS LOCATION ONLY  (Check & Complete if Applicable)
 Description # of Person(s) that Perform Service? EXPLANATION
# of those Person(s) that are Independent Contractors?
 Further Explanation (Only If Needed)
 Body Wraps  Type of Wrap(s)?
 Cosmetologists
 Ear Piercing
 Esthetician I Skin care, waxing / sugaring, body wrap, endothermology, aromatherapy, muscle electrostimulation & lymphatic drainage
 Esthetician II Esthetician I plus electrolysis, microdermabrasion & infrared body wraps
 Esthetician III Esthetician I & II plus chemical peels under 30% acidity
 Manicure/Pedicurists
 Massage Therapists
 Personal Trainer
 Teeth Whitening -
        Self-Administered

 

Name of Product?

 Teeth Whitening -
        LED Light
# of Lights

Name of Product?

 Facial Light Therapy
        (ie: Lumiere, etc)
# of Units

Name of Product?

 Other:

Explanation of Other:

 Other:

Explanation of Other:

 Are all Operators / Trainers Licensed and / or Certified in the applicable jurisdiction where services are provided?Yes  No
 Do you sell retail items (ie Lotions, Tanning Products) at this location? Yes  No
 Have you listed above all of the types of services you provide for this location? Yes  No

 IF you have additional locations, you will be instructed on how to enter them after submitting this form for your first location.

LOCATION #1 (ONLY) PROPERTY INFORMATION
NOTE:
  If you do not wish to carry Property Coverage on your Owned property CLICK HERE to Skip to Underwriting Section

 EXPLANATIONChoose Your Property Deductible:  EXPLANATIONContents Limit:
 EXPLANATIONBuild-Out Limit (only if you are a tenant):  EXPLANATIONBuilding Limit (only if you own the bldg):
 What are your Gross Annual Sales at this Location?
 This will be used to offer you Business Interruption Coverage
 What % of gross sales are during your Peak Season?%
 What are your Peak Season Months? through  Place # of outdoor signs do you have of each?  "0" if None
 Attached to Building     Not Attached to Building
 Building's Construction? Wood Frame  Brick & Wood  Block & Wood  Concrete Block & Steel  Metal and/or Steel
 Approx, Year Built?     Square Feet You Occupy?       What % of total building area do you occupy?
 # of Stories?     Check if a Central Alarm System EXPLANATION for? Burglar  Fire   If Yes, what company installed?
 Is the area of the space you occupy protected by a Sprinkler System?Yes No   If Yes, is it serviced annually?Yes No
 Year of Last Update EXPLANATION?  Plumbing: Heating, A/C: Roof:  Electric:
 What occupies the surrounding area of your business EXPLANATION:  On Left     On Right   In Rear
 List other types of occupants in your building (ie Offices, Retail Stores, Restaurant, etc?

 IF you have additional locations, you will be instructed on how to enter them after submitting this form for your first location.

APPLICABLE TO ALL LOCATIONS - UNDERWRITING INFORMATION

 Do you have a formal Safety Program? Y N Have you ever had a policy cancelled in past 3 years? Y N
 Have any crimes occurred on your premises in past 3 years? Y N Have you had any bankruptcies? Y N
 Have you completed a Tanning Certification Program (check)?
 
NTTI  Smart Tan  State Cert   Other
Is Tanning Exposure controlled by salon operators? Y N
 Is tanning exposure time controlled by a central timer? Y N Is protective eye wear provided & Required? Y N
 Is protective eye wear sanitized after each use? Y N Are beds sanitized after each use? Y N
 Is maximum exposure time w/in mgmt guidelines? Y N Are customer history cards or software used to track sessions?  If Software, Name of? Y N
 Do you provide a drug reaction list? Y N Is there a drug reaction list posted in your store? Y N
 Do you obtain parental consent forms for minors? Y N Do you require parental consent signature prior to minors use of Equipment? Y N
 Are all beds UL Listed? Y N Do you provide Laser services at your store? Y N
 Do you manufacture your own tanning beds? Y N Do you make or blend your own products (lotions, etc)? Y N
 Do you provide any tatooing, permanent cosmetics, or body piercing? Y N Do you sell any products under your business name? Y N
 Are customers required to read & sign acknowledgement of the risks involved with tanning exposures? Y N Do you use independent contractors? Y N
 For ALL Locations are all Operators / Trainers Certified and/or Licensed for the Services you provide? Y N    

 The above information is correct to the best of my knowledge.  Check:   Initials:
   If Enter Button was pressed (Enter Button Submits the Form), use "Tab" key or Mouse to navigate. Submit Button is at bottom.

  We also may have markets available for the following.  Please check if you are interested.
 
 COMMERCIAL AUTO
 
WORKERS COMPENSATION
  If you spoke to someone in our office, please advise who to expedite your quote.

QUESTIONS / HELP

 Contact

Phone (Office)

(412) 271-8888    8:30am - 4:30pm EST   Mon-Fri
Robb Gusic (Direct)  (440) 639-9989

Fax:

 (877) 271-8898

Email:

 robb@thompsongusic.com   


If you have additional locations to enter, please Submit this form and see instructions on next page.

T.R.G.
Copyright 2000 [Thompson-Gusic Insurance Group, Inc.].  ALL RIGHTS RESERVED
Revised: April 06, 2016 .