| Shop Name: * |
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| Shop Owner Name: * |
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| Physical Address Street: * |
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| City: * |
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| State: * |
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| Zip Code: * |
(5 digits) |
| Best Phone #: * |
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| Website: |
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| Email: * |
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| Years in Business: * |
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| Type of Ownership: * |
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| How many shows per year?: * |
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| Prior Insurance? Carrier?: * |
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| Any prior claims or losses?: * |
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| Desired Effective OR Renewal Date: * |
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| General Liability Limits Desired: * |
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| General Liability Definition: |
General Liability - Coverage for an insured when negligent acts result in bodily injury and/or property damage on the premises, when someone is injured as the result of using a product manufactured or distributed by a business, or when someone is injured in the general operation of a business.
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| Professional Liability Limit Desired: * |
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| Professional Liability Definition: |
Professional Liability / E & O Coverage - Professional Liability Insurance protects your company from claims if your client holds you responsible for errors, or your failure to perform the work as promised. |
| Annual Shop Gross Receipts/Sales: * |
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| Name Landlord as Additional Insured?: * |
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| Are you in compliance with City, County, State and Health ordinances?: * |
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| BBP Certified?: * |
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| Do you obtain a signed release/client/medical form on each client?: * |
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| Do check, photocopy, and keep on file client ID?: * |
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| Is staff trained to handle nauseated, fainting, or "under the influence" patrons?: * |
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| You manufacture, mix, or blend products for sale/resale?: * |
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| Is your location maintained in a sanitary manner?: * |
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| Use at least one new pair of gloves with each procedure?: * |
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| Spore Test per State Standards?: * |
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| Shop Sterilizer Make and Model: * |
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| TATTOO OPERATIONS: |
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| Do you reuse needles?: * |
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| Use all single use/disposable needles?: * |
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| Typical # of yrs. of Artists experience in shop: * |
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| Total Tattoo Artists in shop: * |
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| Provide an "aftercare form" for each NEW client procedure?: * |
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| Permanent Makeup?: * |
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| Offer Electrolysis,Esthetician Svcs or Acupuncture?: * |
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| Tattoo Minors?: * |
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| All pigments used "Industry Standards"?: * |
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| Use UV/Glow in dark inks?: * |
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| Ink cups & cord wraps disposable?: * |
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| Dispose of all pigments after each procedure?: * |
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| PIERCING OPERATIONS: |
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| Piercing offered?: * |
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| # of Piercers in shop: * |
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| Typical # of yrs. of Piercers experience in shop: * |
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| Use a piercing gun?: * |
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| Perform Sub Dermal Implants?: * |
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| Pierce Minors with consent form?: * |
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| Provide a written "aftercare form" for each procedure?: * |
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| Do you perform Branding?: * |
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| Do you perform Scarification?: |
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| Use New-Industry approved jewelry for each procedure?: * |
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| SHOP PROPERTY INFORMATION: |
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| How many locations?: * |
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| Occupancy Type: * |
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| Limit for Building Cov. (if owned): |
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| Type of Building you occupy: * |
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| Approx age of building: * |
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If building is over 25 yrs old, what year were the following updated?: |
| Wiring/Electrical: |
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| Plumbing: |
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| Heat - A/C: |
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| Roofing: |
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| How many building stories?: * |
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| Type of Location: * |
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| Square Footage you occupy?: * |
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| Central Station Burglar Alarm? (no theft coverage if not) * |
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| Alarm Serviced By: * |
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| Is there a sprinkler system covering 100% of shop space?: * |
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| Sell Clothing or Jewelry?: * |
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| Total Inventory Value?: * |
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| ATM in the shop?: * |
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| ATM Insured Elsewhere?: * |
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| Total Value of Business/Shop Contents?: * |
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| Monthly Business Income Required - Optional (in case of a loss): |
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| By selecting today's date, it is written warranty that all statements made by you on the above application are true and correct to the best of your knowledge. You are ONLY obtaining quotes at this time.: * |
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| Protect your information: * |
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