Trackless Train Application

1. General Business Information

Enter the basic insured details.

Business Info

Effective Date From *

Effective Date To *

Named Insured *

DBA

FEIN / SS #

Mailing Address *

Phone Number *

Contact Person *

Web Page

Email *

Entity Type *

Years in Business *

Total Estimated Gross Receipts

2. Trackless Train Information

Provide locations, manufacturer, configuration, and operational details (in carrier paper-app order).

Equipment Details

Locations

List each location where the train operates.

Location #	Location Address

Manufacturer of the Train *

If not a major manufacturer, please attach a photo of the train in Section 4.

How Many Cars?

Are There Back Brakes?

Yes No

Does the Train Have a Rearview Mirror to View the Last Car(s)?

Yes No

Who is the Conductor of the Train?

Total Number of Employees / Workers / Volunteers

How Is the Train Transported to Event Sites?

Are Customers: (check all that apply)

Residential Corporate Fair/Festivals Traveling Carnivals

Is There Waiver Signage on or Near the Train, Clearly Visible to All Participants?

Yes No

If yes, send a copy of the waiver signage wording (upload in Section 4).

3. Venue

Mall/strip mall, landlord requirements, and moving-traffic exposure.

Venue Questions

Mall or Strip Mall?

Yes No

Does Landlord Have Special Insurance Requirements?

Yes No

Is the Train Driven in Areas Where There is Moving Traffic, Such as Parking Lots or Outdoor Malls, Driveways and Roads or Pedestrian Walkways?

Yes No

4. Photo of Trackless Train

Please send in a photo of your train(s) along with your application.

Photo Upload

Upload Train Photos

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

5. 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.

6. Warranty & 7. Signature

Complete after reviewing the application above.

Final Step

6. 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.

7. 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.

Trackless Train Application

1. General Business Information

2. Trackless Train Information

Locations

3. Venue

4. Photo of Trackless Train

5. Submission Checklist

Required Checklist

Review Your Application

6. Warranty & 7. Signature

6. Warranty

7. Signature

✅ Application Submitted Successfully!