Tanning Salon Insurance Quote Form

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 :
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

? Yes No

1. What is your proposed Effective Date

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 premium

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

LIABILITY LIMITS & COVERAGE APPLICABLE TO ALL LOCATIONS

Choose your General Liability Occurrence Limit

Choose your General Liability Aggregate Limit

Choose your Professional Liability Limit

Do you wish to carry Employee Benefits Liability

? 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

? MUST BE ANSWERED
What is estimated annual sales from tanning at this location

? 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?	# 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

Choose Your Property Deductible:	Contents Limit:
Build-Out Limit (only if you are a tenant):	Building 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

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

? Plumbing: Heating, A/C: Roof: Electric:

What occupies the surrounding area of your business

: 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 micro ring hair extensions uk lace wig care instructions hair extensions sale top hair care brands brazilian hair wigs cheap cheap wigs uk ombre human hair wigs smp hair transplant human hair extensions mixed race hair types full shine hair extensions coupon cheap hair extensions 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.