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Municipal Entity Underwriting Application

1.

Fireworks

a.

Please list the types of events and scheduled dates.

Type of Event

Date

Type of Event

Date

b.

Are displays conducted by licensed pyrotechnicians?

If no, please explain (e.g. who will set up & launch?  experience?  etc.).  

 Yes

 No

c.

Where is the display held (e.g. river, park, open field, etc.)?

d.

How long will the display last?

e.

Will emergency vehicles be on the premises?

 Yes

 No

f.

Please give the approximate distance from the crowd.

g.

Please give the approximate distance to the nearest structure.

2.

Parks & Recreation Facilities

a.

How many parks are owned by your entity?

b.

# Of Acres.

c.

Is playground equipment inspected?

 Yes

 No

d.

How often?

e.

Is corrective action on equipment documented?

 Yes

 No

f.

How is equipment anchored?

g.

Number of Golf Courses?

Annual Receipts?

Liquor Receipts?

h.

Number of Swimming Pools?

Wading Pools?

Wave Pools?

i.

Are all depths marked?

 Yes

 No

ii.

Any diving boards 3 meters or higher?

 Yes

 No

iii.

Are diving wells 12 feet or deeper?

If no, what is the depth?  

 Yes

 No

iv.

Is the area surrounding the pool(s) fenced?

 Yes

 No

v.

Are pools drained in the off-season?

 Yes

 No

vi.

Are Certified Lifeguards on duty at all times the pool is open?

Please describe type of Certification.  

Number of Lifeguards on duty?  

 Yes

 No

vii.

Are pool regulations posted?

 Yes

 No

viii.

Are employees trained in the use of chlorine?

 Yes

 No

ix.

Is chlorine stored in locked facilities?

 Yes

 No

x.

Are there any waterslides?

If yes, give height, length, and number of curves.  

Depth of entry well?  

Describe supervision in detail.  

 Yes

 No

10 of 3410/23/2007

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