Mechanical Bull Application

1. General Business Information

Enter the basic insured details.

Business Info

Effective Date From *

Effective Date To *

Named Insured *

DBA

FEIN / SS #

Address *

Phone Number *

Contact Person *

Web Page

Email *

Entity Type *

Years in Business *

Total Estimated Gross Receipts

Operators & Payroll

Number of Employed Operators — Full Time

Number of Employed Operators — Part Time

Annual Payroll

Names of All Operators

Are Independent Contractors Ever Used to Operate?

Yes No

2. Bulls

Number, location of operation, and unit details.

Equipment Details

Number of Bulls Owned *

Operation Location

Fixed Site Only?

Yes No

Mobile?

Yes No

Physical Description of Bull(s)

Bull Equipment Details

Add one row per bull. Click "+ Add Bull" for additional units.

Manufacturer Name	City	State	Country	Serial Number	Year Made

3. Site Set-Up

Fencing, padding, venues, and alcohol exposure.

Site Set-Up

Minimum Fenced Radius of 10 Feet or More?

Yes No

Does Device Have Enclosed Inflatable Arena with a Minimum 16-Inch Inflatable Landing?

Yes No

Minimum Ceiling/Overhead Clearance of 12 Feet or More?

Yes No

Base of Unit Completely Covered with Padding?

Yes No

List of Venues Where Ride Will Be Operated (check all that apply)

Is Alcohol Served by the Venue Where the Mechanical Bull is Present?

Yes No

Do Mechanical Bull Operators Monitor for Patron Alcohol Use?

Yes No

4. Operational Related Safety

Inspection, training, and operator standards.

Safety Operations

5. Liability Warnings

Warnings transmitted to riders in advance via posted signs (preferably bilingual English/Spanish).

Posted Warnings

Are warnings transmitted to prospective riders in advance by way of conspicuously posted signs or otherwise (preferably bilingual in English/Spanish) as pertains to the following:

Note: This application MUST include a copy of the Waiver of Liability/Rider Release form used. Such form MUST include a hold harmless agreement in favor of both ride owner and operator as well as outline all terms and conditions the participant agrees to follow. Bilingual language is preferred (English/Spanish). Upload in Section 9 below.

6. Miscellaneous

Receipts breakdown, free rides, prior insurance, and claims history.

Miscellaneous

Estimated Annual Receipts Breakdown

If no separate records are kept, place all revenues in the "Rides" category.

Rides ($)

Photo or Video Tape Receipts ($)

Souvenirs ($)

Clothing ($)

Other ($)

Other — Description

Free Rides

Do You Ever Allow Free Rides?

Yes No

Prior General Liability Insurance

Prior General Liability Insurance Company

Expiration Date

Premium

Claims History

Describe All Claims Arising Out of Your Mechanical Bull Units for the Past 4 Years

7. Cyber Liability

Payment card processing exposure.

Cyber Liability

Do You Process Payment Cards?

Yes No

8. Diagram of Mechanical Bull Set-Up

Provide a diagram of the operational area.

Diagram Upload

Provide a diagram of the operational area to include placement of bull, area of padding, location of fencing or other barriers, distances to spectator area, wall, or any other obstructions.

Upload Set-Up Diagram

JPG, PNG, or PDF accepted. Multiple files OK.

9. Submission Checklist

Confirm all required items are attached.

Submission Checklist

Required Checklist

5 Year Currently Valued Loss Runs No Known/Reported Loss Letter Copy of Rental Agreement/Waiver Safety Rules Pictures of Signage with Hold Harmless Wording

Upload Supporting Documents

Review Your Application

Verify all information before proceeding to sign.

Review

Please review your answers carefully. Use Back to make changes, or Next to proceed to the signature step.

10. Warranty & 11. Signature

Complete after reviewing the application above.

Final Step

10. Warranty

(Applies to all parts of this application and attachments submitted)

It is hereby understood and agreed that if insurance is issued by virtue of completing this application and any applicable supplemental applications, the Insurance is only issued on the reliance on the applicant’s warranty of answers to the questions above and on any such supplemental applications. If, at the time a certificate/policy is issued and ANY OF THE ABOVE WARRANTIES IS IN ANY RESPECT INCORRECT, INCLUDING CLAIMS OR GROSS RECEIPTS, THE COVERAGE AFFORDED UNDER THE CERTIFICATE/POLICY shall, without notice to the applicant, immediately and automatically cease & the certificate/policy shall BECOME NULL AND VOID. Warranties will survive a certificate/policy if issued.

11. Signature

I understand that the insurance company, in determining whether to provide insurance coverage, will rely on the information contained in this form and all other information submitted. I hereby warrant, represent and confirm that, to the best of my knowledge, all information provided is complete, true and correct.

Print Name of Applicant *

Title *

Signature of Applicant (Mandatory) *

Sign above using mouse, trackpad, or touch.

Date * Declaration * I confirm that the information provided in this application is complete, true, and correct to the best of my knowledge.

Mechanical Bull Application

1. General Business Information

Operators & Payroll

2. Bulls

Operation Location

Bull Equipment Details

3. Site Set-Up

List of Venues Where Ride Will Be Operated (check all that apply)

4. Operational Related Safety

5. Liability Warnings

6. Miscellaneous

Estimated Annual Receipts Breakdown

Free Rides

Prior General Liability Insurance

Claims History

7. Cyber Liability

8. Diagram of Mechanical Bull Set-Up

9. Submission Checklist

Required Checklist

Review Your Application

10. Warranty & 11. Signature

10. Warranty

11. Signature

✅ Application Submitted Successfully!