Boarding Kennel/Groom Shop Application

Hidden

Status

Business Name

Owners Name(Required)

First Last

Mailing Address

Address

Street Address Address Line 2 City State ZIP Code

Location Address

Address

Street Address Address Line 2 City State ZIP Code

County

Township/Territory

Business Contact Information

Business Phone

Home Phone

Fax Number

Website Address

Email(Required)

Enter Email Confirm Email

Business Information

How long have you been in business?

How many years experience do you have with this type of business?

Type of Entity:

Sole Proprietor

Partnership

Corporation

Other

Federal ID Number

Current Insurance Company:

Current Insurance Premium:

Have you had any claims in the past 3 years?

If so, please provide date of claim and details below:

Building Information

Do you own the building?

If you are a tentant, do you need glass coverage?

If yes, # of Panes:

Width:

Building 1:
(If you are a tenant only complete the questions with asterisks*)

*Use of Building:

Building Value:

*Business Personal Property Value:

*Construction Type

*Total Sq. Ft:

*# of Stories:

*Year Built:

Building Improvements:

Wiring Year

Roofing Year

Plumbing Year:

Heating Year:

Roof Type:

*Is this building Sprinklered?

If yes, what percentage?

*Is there a Fire Alarm?

Are these alarms:

Central

Local

Building 2:
(If you are a tenant only complete the questions with asterisks*)

*Use of Building:

Building Value

*Business Personal Property Value:

*Construction Type:

*Total Sq. Ft:

*# of Stories:

*Year Built:

Building Improvements:

Wiring Year

Roofing Year

Plumbing Year:

Heating Year:

Roof Type:

*Is this building Sprinklered?

If yes, what percentage?

*Is there a Fire Alarm?

Are these alarms:

Central

Local

Building 3:
(If you are a tenant only complete the questions with asterisks*)

*Use of Building:

Building Value:

*Business Personal Property Value:

*Construction Type:

*Total Sq. Ft:

*# of Stories:

*Year Built:

Building Improvements:

Wiring Year

Roofing Year

Plumbing Year

Heating Year:

Roof Type:

*Is this building Sprinklered?

If yes, what percentage?

*Is there a Fire Alarm?

Are these alarms:

Central

Local

How many miles to the nearest fire department:

Distance to fire hydrant:

Kennel Surface:

Stone

Concrete

Dirt

Other

Optional Coverages

Business Computer Value

Which building is computer located?

Value of fencing attached to building:

Value of fencing not attached to building:

Value of Sign:

Questions

Are you a member of the Amercian Boarding Kennel Association?

Are you a member of the American Groom Shop Association?

Number of animals boarded when full?

Average boarded per week?

Approximate annual boarding receipts?

Do you provide a "Boarding Contract" for your customers?

If yes, please upload a PDF here:

Accepted file types: pdf, Max. file size: 10 MB.

(MUST be a PDF document)

Do you provide grooming services?

If yes, # of animals groomed daily?

Annual Receipts?

Do you breed animals?

If yes, name of breed(s):

If you breed, how many litters per year?

Maximum value of each litter:

Do you provide any training?

If yes, type of training:

Do you employ a Veterinarian?

If yes, Number of Veterinarians:

Annual Receipts:

Do you have an evacuation plan in place to remove animals in case of a fire?

This application does not bind the applicant nor the Company to complete the insurance, but it is agreed that the information contained herein shall be the basis on the contract should a policy be issued.

Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

Dog Trainer Supplemental General Liability Form

Please complete this form below only if you indicated you provide Dog Training.

What kind of training are you qualified to do?

How many years have you been a trainer?

What professional organizations do you belong to?

Do you train on your premises?

Do you train off premises?

If you train off premises do you have one specific location or several?

If you train off premises, how often?

Are you a professional dog handler?

How many dogs have you titled in shows and/or trials?

What breeds do you train

Estimated Gross Annual Receipts?

For over 20 years, Kennel Pak, Inc. has provided the boarding kennel industry a unique insurance package that cannot be offered by any other St. Paul/Travelers representative. The Kennel Pak policy combines property and liability covers for both your business and home if they are located on the same property.

Kennel Pak, Inc. is a registered trademark and has been trademarked since 1986. We are endorsed by the American Boarding Kennels Association and have kept that endorsement since 1987. No other agent, broker or organization may use "Kennel Pak" or marker our insurance program without the express written consent of Gentzler & Smith Associates, Inc. and/or Kennel Pak, Inc.

By signing this part of the application, you are authorizing Kennel Pak, Inc. & Gentzler & Smith Associates, Inc. to obtain a quote via our program with the St. Paul/Travelers Insurance Company.

Flood Insurance Notice / Rejection

Flood insurance is available under the National Flood Insurance Program (NFIP) in over 18,000 communities nationwide. It provides coverage for residential and non-residential buildings and their contents, in both high risk as well as low risk areas. Historically, about one quarter of all losses under the NFIP are in low risk areas.

The standard homeowners or commercial property insurance policy typically exlcudes or does not otherwise provide coverage for flooding events. Purchasing separate flood insurance coverage will allow covered flood losses to be adjusted in a similar manner as losses from other perils in other property policies.

The Federal Emergency Management Agency (FEMA) advises that although federal disaster relief assistance is sometimes available after a flood, such financial assistance is typically in the form of a loan and must be repaid to the Government in addition to any other outstanding loans.