Zorbs & Spheres 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. Zorbs

Ground-use questions for zorbs (per carrier paper §2).

Zorbs / Ground Use

Total Number of Zorbs *

Manufacturer

Employee Present at All Times?

Yes No

Employee to Participant Ratio

Do You Use Waivers/Signage with Hold Harmless Wording?

Yes No

Is the Inflatable Track Always Set Up on Level Ground?

Yes No

Any Downhill Usage?

Yes No

3. Bobbles, Hamster Balls, Spheres, Water Balls, Rollers

Water-use questions (per carrier paper §3).

Water Use

Total Number of Bobbles, Hamster Balls, Spheres, Water Ball Rollers

Manufacturer

Employee Present at All Times?

Yes No

Employee to Participant Ratio

Do You Use Waivers/Signage with Hold Harmless Wording?

Yes No

Inflatable Pool?

Yes No

Depth of Water

How Long Are Riders Inside of the Ball?

How Many Riders Are in the Pool at One Time?

How Are Operators Trained in Case of Emergencies?

Are the Manufacturer's Warning and Safety Signs Clearly Posted at the Attraction?

Yes No

Do You Restrict Only One Participant per Ball?

Yes No

Any Downhill Usage?

Yes No

One Timer per Bobble / Hamster Ball / Sphere / Water Ball / Roller / Zorb is Required *

Please initial to confirm you understand:

4. 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 Equipment Photos

Upload Training / Safety Records

Upload Supporting Documents

Upload Additional Photos

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.

5. Warranty & 6. Signature

Complete after reviewing the application above.

Final Step

5. 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.

6. 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.

Zorbs & Spheres Application

1. General Business Information

2. Zorbs

3. Bobbles, Hamster Balls, Spheres, Water Balls, Rollers

4. Submission Checklist

Required Checklist

Review Your Application

5. Warranty & 6. Signature

5. Warranty

6. Signature

✅ Application Submitted Successfully!